|
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
|
|
|
FLUOROGUIDE FOR SPINE INJEC(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320P0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$120.44 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Ambetter Exchange |
$92.65
|
| Rate for Payer: Anthem Medicaid |
$52.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$108.13
|
| Rate for Payer: Healthspan PPO |
$86.27
|
| Rate for Payer: Humana Medicaid |
$52.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.34
|
| Rate for Payer: Molina Healthcare Passport |
$52.29
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.44
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.65
|
|
|
FLUOROGUIDE FOR SPINE INJEC(T
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320T0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.06
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
FLUOROGUIDE FOR SPINE INJEC(T
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320T0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem Medicaid |
$369.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Humana KY Medicaid |
$369.35
|
| Rate for Payer: Kentucky WC Medicaid |
$373.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.06
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Humana KY Medicaid |
$389.98
|
| Rate for Payer: Kentucky WC Medicaid |
$393.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Ambetter Exchange |
$92.65
|
| Rate for Payer: Anthem Medicaid |
$52.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.18
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$108.13
|
| Rate for Payer: Healthspan PPO |
$86.27
|
| Rate for Payer: Humana Medicaid |
$52.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.34
|
| Rate for Payer: Molina Healthcare Passport |
$52.29
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.44
|
| Rate for Payer: UHCCP Medicaid |
$396.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.65
|
|
|
FLUORO GUIDE NEEDLE PLACE (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320P1013
|
|
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 GUIDE NEEDLE PLACE (T
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T1013
|
|
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
|
|
|
FLUORO GUIDE NEEDLE PLACE (T
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T1013
|
|
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 Medicaid |
$267.21
|
| 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: Humana KY Medicaid |
$267.21
|
| Rate for Payer: Kentucky WC Medicaid |
$269.93
|
| 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: Molina Healthcare Medicaid |
$272.57
|
| 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
|
|
|
FLUOROMETHALINE 0.1% OPTH SUSP
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60758088010
|
| Hospital Charge Code |
25000695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem Medicaid |
$0.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Humana KY Medicaid |
$0.98
|
| Rate for Payer: Kentucky WC Medicaid |
$0.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.97
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
FLUOROMETHALINE 0.1% OPTH SUSP
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60758088010
|
| Hospital Charge Code |
25000695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.97
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
FLUOROMETHOLONE 0.1%EYESUSP5ML
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
25003073
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna Commercial |
$2.59
|
| Rate for Payer: First Health Commercial |
$2.96
|
| Rate for Payer: Humana Commercial |
$2.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.75
|
| Rate for Payer: Ohio Health Group HMO |
$2.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.15
|
| Rate for Payer: PHCS Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Payer |
$2.75
|
|
|
FLUOROMETHOLONE 0.1%EYESUSP5ML
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
25003073
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Anthem Medicaid |
$1.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna Commercial |
$2.59
|
| Rate for Payer: First Health Commercial |
$2.96
|
| Rate for Payer: Humana Commercial |
$2.65
|
| Rate for Payer: Humana KY Medicaid |
$1.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.75
|
| Rate for Payer: Ohio Health Group HMO |
$2.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.15
|
| Rate for Payer: PHCS Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Payer |
$2.75
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
FLUOROSCOPIC GUIDANCE
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Ambetter Exchange |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.45
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.15
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.04
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem Medicaid |
$248.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Humana KY Medicaid |
$248.98
|
| Rate for Payer: Kentucky WC Medicaid |
$251.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$499.56
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$931.20 |
| Rate for Payer: Aetna Commercial |
$746.90
|
| Rate for Payer: Anthem Medicaid |
$333.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$756.60
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$805.10
|
| Rate for Payer: First Health Commercial |
$921.50
|
| Rate for Payer: Humana Commercial |
$824.50
|
| Rate for Payer: Humana KY Medicaid |
$333.58
|
| Rate for Payer: Kentucky WC Medicaid |
$336.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$853.60
|
| Rate for Payer: Ohio Health Group HMO |
$727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.30
|
| Rate for Payer: PHCS Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Payer |
$853.60
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$499.56
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
FLUOROSCOPIC GUIDANCE
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Ambetter Exchange |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.45
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.15
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.04
|
|
|
FLUOROSCOPIC GUIDANCE(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761P2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Ambetter Exchange |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.45
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.15
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.04
|
|
|
FLUOROSCOPIC GUIDANCE(T
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761T2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
FLUOROSCOPIC GUIDANCE(T
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761T2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
