|
FNA BX W/CT GDN EA ADDL(P
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761P0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$445.49 |
| Rate for Payer: Ambetter Exchange |
$68.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.32
|
| Rate for Payer: Anthem Medicaid |
$213.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.72
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$445.49
|
| Rate for Payer: Humana Medicaid |
$213.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.22
|
| Rate for Payer: Molina Healthcare Passport |
$213.94
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$89.61
|
| Rate for Payer: UHCCP Medicaid |
$42.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.93
|
|
|
FNA BX W/CT GDN EA ADDL(T
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761T0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
FNA BX W/CT GDN EA ADDL(T
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 10010
|
| Hospital Charge Code |
761T0004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
FNA BX W/O IMG GDN EA ADDL
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 10004
|
| Hospital Charge Code |
76102980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$551.40 |
| Rate for Payer: Ambetter Exchange |
$41.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$41.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.34
|
| Rate for Payer: Cash Price |
$459.50
|
| Rate for Payer: Cash Price |
$459.50
|
| Rate for Payer: Cigna Commercial |
$85.21
|
| Rate for Payer: Humana Medicaid |
$41.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.38
|
| Rate for Payer: Molina Healthcare Passport |
$41.55
|
| Rate for Payer: Multiplan PHCS |
$551.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.46
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.12
|
|
|
FNA BX W/O IMG GDN EA ADDL (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 10004
|
| Hospital Charge Code |
761P2980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Ambetter Exchange |
$41.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$41.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.34
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$85.21
|
| Rate for Payer: Humana Medicaid |
$41.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.38
|
| Rate for Payer: Molina Healthcare Passport |
$41.55
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$53.46
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.12
|
|
|
FNA BX W/O IMG GDN EA ADDL (T
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 10004
|
| Hospital Charge Code |
761T2980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem Medicaid |
$230.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.82
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Humana KY Medicaid |
$230.07
|
| Rate for Payer: Kentucky WC Medicaid |
$232.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
FNA BX W/O IMG GDN EA ADDL (T
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 10004
|
| Hospital Charge Code |
761T2980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.82
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
FNA BX W/US GDN EA ADDL
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$48.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$48.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.99
|
| Rate for Payer: Molina Healthcare Passport |
$48.03
|
| Rate for Payer: Multiplan PHCS |
$427.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
IP
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
FNA BX W/US GDN EA ADDL
|
Facility
|
OP
|
$713.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
76100002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.90 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$549.01
|
| Rate for Payer: Anthem Medicaid |
$245.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$556.14
|
| Rate for Payer: Cash Price |
$356.50
|
| Rate for Payer: Cigna Commercial |
$591.79
|
| Rate for Payer: First Health Commercial |
$677.35
|
| Rate for Payer: Humana Commercial |
$606.05
|
| Rate for Payer: Humana KY Medicaid |
$245.20
|
| Rate for Payer: Kentucky WC Medicaid |
$247.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$584.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$526.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$627.44
|
| Rate for Payer: Ohio Health Group HMO |
$534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.97
|
| Rate for Payer: PHCS Commercial |
$684.48
|
| Rate for Payer: United Healthcare All Payer |
$627.44
|
|
|
FNA BX W/US GDN EA ADDL(P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761P0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.02 |
| Max. Negotiated Rate |
$111.00 |
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.02
|
| Rate for Payer: Anthem Medicaid |
$48.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$98.07
|
| Rate for Payer: Humana Medicaid |
$48.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.99
|
| Rate for Payer: Molina Healthcare Passport |
$48.03
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
FNA BX W/US GDN EA ADDL(T
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
FNA BX W/US GDN EA ADDL(T
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 10006
|
| Hospital Charge Code |
761T0002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
FOLATE
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.08
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
FOLATE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Ambetter Exchange |
$14.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$14.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$14.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$12.95
|
| Rate for Payer: Healthspan PPO |
$15.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$14.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Multiplan PHCS |
$79.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.11
|
| Rate for Payer: UHCCP Medicaid |
$46.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$14.70
|
|
|
FOLATE
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$14.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.70
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$14.70
|
| Rate for Payer: Humana Medicare Advantage |
$14.70
|
| Rate for Payer: Kentucky WC Medicaid |
$14.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.08
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
FOLIC ACID 1 MG TABLE 1MG/1TAB
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
25000699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
FOLIC ACID 1 MG TABLE 1MG/1TAB
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
25000699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.02
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.82 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Ambetter Exchange |
$18.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.76
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.39
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.76
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.15
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510P0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Ambetter Exchange |
$18.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.51
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.76
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.39
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.76
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(T
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510T0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(T
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510T0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
FOLVITE(FOLIC ACID)(0.1MG)50MG
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
25003076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$65.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$65.68
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
