|
FLUOCINONIDE-E 0.05% CRM 30GM
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 51672125402
|
| Hospital Charge Code |
25003899
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.11
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cigna Commercial |
$8.63
|
| Rate for Payer: First Health Commercial |
$9.88
|
| Rate for Payer: Humana Commercial |
$8.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.15
|
| Rate for Payer: Ohio Health Group HMO |
$7.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.18
|
| Rate for Payer: PHCS Commercial |
$9.98
|
| Rate for Payer: United Healthcare All Payer |
$9.15
|
|
|
FLUORESCITE 10% 5 ML 500MG/5ML
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
NDC 81298866003
|
| Hospital Charge Code |
25003072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem Medicaid |
$117.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Humana KY Medicaid |
$117.27
|
| Rate for Payer: Kentucky WC Medicaid |
$118.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
FLUORESCITE 10% 5 ML 500MG/5ML
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
NDC 81298866003
|
| Hospital Charge Code |
25003072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.29
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
FLUOR I STRIP 300 (EACH ST 1EA
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
25000694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
FLUOR I STRIP 300 (EACH ST 1EA
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
25000694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$487.80 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Ambetter Exchange |
$28.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$134.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.85
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$134.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.39
|
| Rate for Payer: Molina Healthcare Passport |
$134.70
|
| Rate for Payer: Multiplan PHCS |
$487.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.67
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.21
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Ambetter Exchange |
$28.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$134.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.85
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$134.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.39
|
| Rate for Payer: Molina Healthcare Passport |
$134.70
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.67
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.21
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem Medicaid |
$278.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Humana KY Medicaid |
$278.56
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$281.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
FLUORO EXAM OF G/COLON TUBE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320P1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Ambetter Exchange |
$28.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$134.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.85
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$134.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.39
|
| Rate for Payer: Molina Healthcare Passport |
$134.70
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.67
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.21
|
|
|
FLUORO EXAM OF G/COLON TUBE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761P2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Ambetter Exchange |
$28.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$134.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.85
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$134.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.39
|
| Rate for Payer: Molina Healthcare Passport |
$134.70
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.67
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$136.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.21
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761T2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem Medicaid |
$142.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Humana KY Medicaid |
$142.03
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$143.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320T1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Humana KY Medicaid |
$141.00
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$142.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.90
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320T1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$356.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.90
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761T2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Ambetter Exchange |
$102.20
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| Rate for Payer: Multiplan PHCS |
$511.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.86
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.20
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem Medicaid |
$293.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Humana KY Medicaid |
$293.00
|
| Rate for Payer: Kentucky WC Medicaid |
$295.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem Medicaid |
$293.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Humana KY Medicaid |
$293.00
|
| Rate for Payer: Kentucky WC Medicaid |
$295.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Ambetter Exchange |
$102.20
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| Rate for Payer: Multiplan PHCS |
$511.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.86
|
| Rate for Payer: UHCCP Medicaid |
$298.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.20
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
FLUORO GUIDANCE NEEDLE PLACE(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320P0223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$132.86 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Ambetter Exchange |
$102.20
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$102.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$102.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.86
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$102.20
|
|
|
FLUORO GUIDANCE NEEDLE PLACE(T
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T0223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.13
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
