|
INCISION OF SPINAL NERVE
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.45
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INCISION OF SPINAL NERVE(P
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
761P2367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.42 |
| Max. Negotiated Rate |
$1,495.00 |
| Rate for Payer: Aetna Commercial |
$903.55
|
| Rate for Payer: Anthem Medicaid |
$412.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,495.00
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$801.01
|
| Rate for Payer: Healthspan PPO |
$705.47
|
| Rate for Payer: Humana Medicaid |
$412.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$734.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.67
|
| Rate for Payer: Molina Healthcare Passport |
$412.42
|
| Rate for Payer: Multiplan PHCS |
$897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,046.50
|
| Rate for Payer: UHCCP Medicaid |
$523.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.54
|
|
|
INCISION OF TENDON & MUSCLE
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem Medicaid |
$557.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Humana KY Medicaid |
$557.12
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$568.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.20
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
INCISION OF TENDON & MUSCLE
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$928.11
|
| Rate for Payer: Anthem Medicaid |
$458.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,620.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,015.82
|
| Rate for Payer: Healthspan PPO |
$840.67
|
| Rate for Payer: Humana Medicaid |
$458.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$777.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.00
|
| Rate for Payer: Molina Healthcare Passport |
$458.82
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,134.00
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.41
|
|
|
INCISION OF TENDON & MUSCLE
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$502.20
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
INCISION OF TENDON & MUSCLE(P
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
761P0455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$928.11
|
| Rate for Payer: Anthem Medicaid |
$458.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,620.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,015.82
|
| Rate for Payer: Healthspan PPO |
$840.67
|
| Rate for Payer: Humana Medicaid |
$458.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$777.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.00
|
| Rate for Payer: Molina Healthcare Passport |
$458.82
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,134.00
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.41
|
|
|
INCISION OF TENDON SHEATH
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$744.96 |
| Rate for Payer: Aetna Commercial |
$597.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$605.28
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$644.08
|
| Rate for Payer: First Health Commercial |
$737.20
|
| Rate for Payer: Humana Commercial |
$659.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$636.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.88
|
| Rate for Payer: Ohio Health Group HMO |
$582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.56
|
| Rate for Payer: PHCS Commercial |
$744.96
|
| Rate for Payer: United Healthcare All Payer |
$682.88
|
|
|
INCISION OF TENDON SHEATH
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.64 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Anthem Medicaid |
$214.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$641.66
|
| Rate for Payer: Healthspan PPO |
$445.12
|
| Rate for Payer: Humana Medicaid |
$214.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.93
|
| Rate for Payer: Molina Healthcare Passport |
$214.64
|
| Rate for Payer: Multiplan PHCS |
$465.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.20
|
| Rate for Payer: UHCCP Medicaid |
$271.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.79
|
|
|
INCISION OF TENDON SHEATH
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$597.52
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$605.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$644.08
|
| Rate for Payer: First Health Commercial |
$737.20
|
| Rate for Payer: Humana Commercial |
$659.60
|
| Rate for Payer: Humana KY Medicaid |
$266.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$269.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$636.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.88
|
| Rate for Payer: Ohio Health Group HMO |
$582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.56
|
| Rate for Payer: PHCS Commercial |
$744.96
|
| Rate for Payer: United Healthcare All Payer |
$682.88
|
|
|
INCISION OF TENDON SHEATH(P
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
761P0564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.64 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Anthem Medicaid |
$214.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$641.66
|
| Rate for Payer: Healthspan PPO |
$445.12
|
| Rate for Payer: Humana Medicaid |
$214.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.93
|
| Rate for Payer: Molina Healthcare Passport |
$214.64
|
| Rate for Payer: Multiplan PHCS |
$465.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.20
|
| Rate for Payer: UHCCP Medicaid |
$271.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.79
|
|
|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$1,027.20 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.70
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Humana KY Medicaid |
$367.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$371.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.70
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$379.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$120.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,070.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$430.74
|
| Rate for Payer: Healthspan PPO |
$472.90
|
| Rate for Payer: Humana Medicaid |
$120.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$306.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.18
|
| Rate for Payer: Molina Healthcare Passport |
$120.76
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.00
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.97
|
|
|
INCISION OF TOE TENDON(P
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
761P0995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$379.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$120.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,070.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$430.74
|
| Rate for Payer: Healthspan PPO |
$472.90
|
| Rate for Payer: Humana Medicaid |
$120.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$306.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.18
|
| Rate for Payer: Molina Healthcare Passport |
$120.76
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.00
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.97
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
INCISION OF URETHRA
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$160.67
|
| Rate for Payer: Anthem Medicaid |
$76.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: Healthspan PPO |
$128.47
|
| Rate for Payer: Humana Medicaid |
$76.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.64
|
| Rate for Payer: Molina Healthcare Passport |
$76.12
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.88
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
INCISION OF URETHRA(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
761P2116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$160.67
|
| Rate for Payer: Anthem Medicaid |
$76.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: Healthspan PPO |
$128.47
|
| Rate for Payer: Humana Medicaid |
$76.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.64
|
| Rate for Payer: Molina Healthcare Passport |
$76.12
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.88
|
|
|
INCRUSE ELIPTA 30 DOSE INHALER
|
Facility
|
OP
|
$31.97
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Humana Commercial |
$27.17
|
| Rate for Payer: Humana KY Medicaid |
$10.99
|
| Rate for Payer: Kentucky WC Medicaid |
$11.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.13
|
| Rate for Payer: Ohio Health Group HMO |
$23.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.91
|
| Rate for Payer: PHCS Commercial |
$30.69
|
| Rate for Payer: United Healthcare All Payer |
$28.13
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Anthem Medicaid |
$10.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.94
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cigna Commercial |
$26.54
|
| Rate for Payer: First Health Commercial |
$30.37
|
|
|
INCRUSE ELIPTA 30 DOSE INHALER
|
Facility
|
IP
|
$31.97
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.94
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cigna Commercial |
$26.54
|
| Rate for Payer: First Health Commercial |
$30.37
|
| Rate for Payer: Humana Commercial |
$27.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.13
|
| Rate for Payer: Ohio Health Group HMO |
$23.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.91
|
| Rate for Payer: PHCS Commercial |
$30.69
|
| Rate for Payer: United Healthcare All Payer |
$28.13
|
|
|
INCRUSE ELIPTA 7 DOSE INHALER
|
Facility
|
OP
|
$44.29
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$34.10
|
| Rate for Payer: Anthem Medicaid |
$15.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.55
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: First Health Commercial |
$42.08
|
| Rate for Payer: Humana Commercial |
$37.65
|
| Rate for Payer: Humana KY Medicaid |
$15.23
|
| Rate for Payer: Kentucky WC Medicaid |
$15.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.98
|
| Rate for Payer: Ohio Health Group HMO |
$33.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.73
|
| Rate for Payer: PHCS Commercial |
$42.52
|
| Rate for Payer: United Healthcare All Payer |
$38.98
|
|
|
INCRUSE ELIPTA 7 DOSE INHALER
|
Facility
|
IP
|
$44.29
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$34.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.55
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: First Health Commercial |
$42.08
|
| Rate for Payer: Humana Commercial |
$37.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.98
|
| Rate for Payer: Ohio Health Group HMO |
$33.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.73
|
| Rate for Payer: PHCS Commercial |
$42.52
|
| Rate for Payer: United Healthcare All Payer |
$38.98
|
|
|
INDERAL LA(PROPRANOL 60MG/1CAP
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 527411637
|
| Hospital Charge Code |
25000777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
INDERAL LA(PROPRANOL 60MG/1CAP
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 527411637
|
| Hospital Charge Code |
25000777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| 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 |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
INDERAL LA(PROPRANOL 80MG/1CAP
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
25000778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
