|
ANALYZE NEURO WITHOUT PROGRAMI
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
ANALYZE NEURO WITHOUT PROGRAMI
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$401.28 |
| Rate for Payer: Aetna Commercial |
$321.86
|
| Rate for Payer: Anthem Medicaid |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$326.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cash Price |
$209.00
|
| Rate for Payer: Cigna Commercial |
$346.94
|
| Rate for Payer: First Health Commercial |
$397.10
|
| Rate for Payer: Humana Commercial |
$355.30
|
| Rate for Payer: Humana KY Medicaid |
$143.75
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$145.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$342.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$308.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$367.84
|
| Rate for Payer: Ohio Health Group HMO |
$313.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$334.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$363.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.42
|
| Rate for Payer: PHCS Commercial |
$401.28
|
| Rate for Payer: United Healthcare All Payer |
$367.84
|
|
|
ANALYZE NEURO W/O PROGRAMI(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510P0041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$35.07
|
| Rate for Payer: Ambetter Exchange |
$17.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.48
|
| Rate for Payer: Anthem Medicaid |
$17.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$74.64
|
| Rate for Payer: Healthspan PPO |
$66.24
|
| Rate for Payer: Humana Medicaid |
$17.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.91
|
| Rate for Payer: Molina Healthcare Passport |
$17.56
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.53
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.33
|
|
|
ANALYZE NEURO W/O PROGRAMI(T
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510T0041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$257.28 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem Medicaid |
$92.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Humana KY Medicaid |
$92.17
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$93.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.92
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
ANALYZE NEURO W/O PROGRAMI(T
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510T0041
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$257.28 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.04
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.92
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
ANALYZE SPINE INFUS PUMP
|
Facility
|
OP
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.84 |
| Max. Negotiated Rate |
$753.26 |
| Rate for Payer: Aetna Commercial |
$604.18
|
| Rate for Payer: Anthem Medicaid |
$269.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$651.26
|
| Rate for Payer: First Health Commercial |
$745.42
|
| Rate for Payer: Humana Commercial |
$666.95
|
| Rate for Payer: Humana KY Medicaid |
$269.84
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$272.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.49
|
| Rate for Payer: Ohio Health Group HMO |
$588.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.41
|
| Rate for Payer: PHCS Commercial |
$753.26
|
| Rate for Payer: United Healthcare All Payer |
$690.49
|
|
|
ANALYZE SPINE INFUS PUMP
|
Facility
|
IP
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$753.26 |
| Rate for Payer: Aetna Commercial |
$604.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.03
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$651.26
|
| Rate for Payer: First Health Commercial |
$745.42
|
| Rate for Payer: Humana Commercial |
$666.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.49
|
| Rate for Payer: Ohio Health Group HMO |
$588.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.41
|
| Rate for Payer: PHCS Commercial |
$753.26
|
| Rate for Payer: United Healthcare All Payer |
$690.49
|
|
|
ANALYZE SPINE INFUS PUMP
|
Professional
|
Both
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$470.79 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Ambetter Exchange |
$23.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.81
|
| Rate for Payer: Anthem Medicaid |
$30.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.71
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$30.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.19
|
| Rate for Payer: Molina Healthcare Passport |
$30.58
|
| Rate for Payer: Multiplan PHCS |
$470.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.02
|
| Rate for Payer: UHCCP Medicaid |
$13.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.09
|
|
|
ANALYZE SPINE INFUS PUMP(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761P2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Ambetter Exchange |
$23.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.81
|
| Rate for Payer: Anthem Medicaid |
$30.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$23.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$23.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.71
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$30.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$23.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.19
|
| Rate for Payer: Molina Healthcare Passport |
$30.58
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$30.02
|
| Rate for Payer: UHCCP Medicaid |
$13.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$23.09
|
|
|
ANALYZE SPINE INFUS PUMP(T
|
Facility
|
OP
|
$634.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761T2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.26 |
| Max. Negotiated Rate |
$609.26 |
| Rate for Payer: Aetna Commercial |
$488.68
|
| Rate for Payer: Anthem Medicaid |
$218.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cigna Commercial |
$526.76
|
| Rate for Payer: First Health Commercial |
$602.92
|
| Rate for Payer: Humana Commercial |
$539.45
|
| Rate for Payer: Humana KY Medicaid |
$218.26
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$220.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.49
|
| Rate for Payer: Ohio Health Group HMO |
$475.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.91
|
| Rate for Payer: PHCS Commercial |
$609.26
|
| Rate for Payer: United Healthcare All Payer |
$558.49
|
|
|
ANALYZE SPINE INFUS PUMP(T
|
Facility
|
IP
|
$634.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761T2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$609.26 |
| Rate for Payer: Aetna Commercial |
$488.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.03
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cigna Commercial |
$526.76
|
| Rate for Payer: First Health Commercial |
$602.92
|
| Rate for Payer: Humana Commercial |
$539.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.49
|
| Rate for Payer: Ohio Health Group HMO |
$475.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.91
|
| Rate for Payer: PHCS Commercial |
$609.26
|
| Rate for Payer: United Healthcare All Payer |
$558.49
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Professional
|
Both
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$719.72 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Ambetter Exchange |
$32.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$39.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.71
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$83.37
|
| Rate for Payer: Healthspan PPO |
$67.65
|
| Rate for Payer: Humana Medicaid |
$39.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.22
|
| Rate for Payer: Molina Healthcare Passport |
$39.43
|
| Rate for Payer: Multiplan PHCS |
$719.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.94
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.26
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
OP
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$1,151.56 |
| Rate for Payer: Aetna Commercial |
$923.65
|
| Rate for Payer: Anthem Medicaid |
$412.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$995.62
|
| Rate for Payer: First Health Commercial |
$1,139.56
|
| Rate for Payer: Humana Commercial |
$1,019.61
|
| Rate for Payer: Humana KY Medicaid |
$412.52
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$416.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.60
|
| Rate for Payer: Ohio Health Group HMO |
$899.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$827.68
|
| Rate for Payer: PHCS Commercial |
$1,151.56
|
| Rate for Payer: United Healthcare All Payer |
$1,055.60
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
IP
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.86 |
| Max. Negotiated Rate |
$1,151.56 |
| Rate for Payer: Aetna Commercial |
$923.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.64
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$995.62
|
| Rate for Payer: First Health Commercial |
$1,139.56
|
| Rate for Payer: Humana Commercial |
$1,019.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.60
|
| Rate for Payer: Ohio Health Group HMO |
$899.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$827.68
|
| Rate for Payer: PHCS Commercial |
$1,151.56
|
| Rate for Payer: United Healthcare All Payer |
$1,055.60
|
|
|
ANALYZE SP INF PUMP W/REPRO(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761P2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Ambetter Exchange |
$32.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$39.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$32.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.71
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$83.37
|
| Rate for Payer: Healthspan PPO |
$67.65
|
| Rate for Payer: Humana Medicaid |
$39.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$32.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.22
|
| Rate for Payer: Molina Healthcare Passport |
$39.43
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.94
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.26
|
|
|
ANALYZE SP INF PUMP W/REPRO(T
|
Facility
|
IP
|
$699.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761T2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.86 |
| Max. Negotiated Rate |
$671.56 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.64
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cigna Commercial |
$580.62
|
| Rate for Payer: First Health Commercial |
$664.56
|
| Rate for Payer: Humana Commercial |
$594.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.60
|
| Rate for Payer: Ohio Health Group HMO |
$524.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$559.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.68
|
| Rate for Payer: PHCS Commercial |
$671.56
|
| Rate for Payer: United Healthcare All Payer |
$615.60
|
|
|
ANALYZE SP INF PUMP W/REPRO(T
|
Facility
|
OP
|
$699.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761T2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.57 |
| Max. Negotiated Rate |
$671.56 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Anthem Medicaid |
$240.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$387.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.10
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cigna Commercial |
$580.62
|
| Rate for Payer: First Health Commercial |
$664.56
|
| Rate for Payer: Humana Commercial |
$594.61
|
| Rate for Payer: Humana KY Medicaid |
$240.57
|
| Rate for Payer: Humana Medicare Advantage |
$277.11
|
| Rate for Payer: Kentucky WC Medicaid |
$243.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.60
|
| Rate for Payer: Ohio Health Group HMO |
$524.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$559.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.68
|
| Rate for Payer: PHCS Commercial |
$671.56
|
| Rate for Payer: United Healthcare All Payer |
$615.60
|
|
|
ANATOMICAL SHLD PEG GLND LG
|
Facility
|
OP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem Medicaid |
$2,855.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Humana KY Medicaid |
$2,855.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,884.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,912.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHLD PEG GLND LG
|
Facility
|
IP
|
$8,303.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,491.03 |
| Max. Negotiated Rate |
$7,971.31 |
| Rate for Payer: Aetna Commercial |
$6,393.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,476.69
|
| Rate for Payer: Cash Price |
$4,151.73
|
| Rate for Payer: Cigna Commercial |
$6,891.86
|
| Rate for Payer: First Health Commercial |
$7,888.28
|
| Rate for Payer: Humana Commercial |
$7,057.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,808.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,127.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,491.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,307.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,227.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,642.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,729.38
|
| Rate for Payer: PHCS Commercial |
$7,971.31
|
| Rate for Payer: United Healthcare All Payer |
$7,307.04
|
|
|
ANATOMICAL SHLDR KEEL GLND LG
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
ANATOMICAL SHLDR KEEL GLND LG
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
ANATOMICAL SHLDR KEEL GLND SM
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
ANATOMICAL SHLDR KEEL GLND SM
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
ANATOMICAL SHLDR KELL GLND MED
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
ANATOMICAL SHLDR KELL GLND MED
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,704.75 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,546.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,943.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.93
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
