|
INFUSE RADIOACTIVE MATERIAL
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$1,377.60 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$444.85
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
|
INFUSE RADIOACTIVE MATERIAL(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
333P0029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$232.97 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$529.55
|
| Rate for Payer: Anthem Medicaid |
$232.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$463.90
|
| Rate for Payer: Healthspan PPO |
$446.58
|
| Rate for Payer: Humana Medicaid |
$232.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.63
|
| Rate for Payer: Molina Healthcare Passport |
$232.97
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.30
|
|
|
INFUSE RADIOACTIVE MATERIAL(T
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
333T0029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
INFUSE RADIOACTIVE MATERIAL(T
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
333T0029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem Medicaid |
$201.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.74
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Humana KY Medicaid |
$201.18
|
| Rate for Payer: Humana Medicare Advantage |
$232.40
|
| Rate for Payer: Kentucky WC Medicaid |
$203.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
INFUSION PORT 6F
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
INFUSION PORT 6F
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
INFUVITE PED 5mL SDV
|
Facility
|
OP
|
$131.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Anthem Medicaid |
$45.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.22
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna Commercial |
$108.77
|
| Rate for Payer: First Health Commercial |
$124.50
|
| Rate for Payer: Humana Commercial |
$111.39
|
| Rate for Payer: Humana KY Medicaid |
$45.07
|
| Rate for Payer: Kentucky WC Medicaid |
$45.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.32
|
| Rate for Payer: Ohio Health Group HMO |
$98.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.63
|
| Rate for Payer: PHCS Commercial |
$125.81
|
| Rate for Payer: United Healthcare All Payer |
$115.32
|
|
|
INFUVITE PED 5mL SDV
|
Facility
|
IP
|
$131.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.22
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cigna Commercial |
$108.77
|
| Rate for Payer: First Health Commercial |
$124.50
|
| Rate for Payer: Humana Commercial |
$111.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.32
|
| Rate for Payer: Ohio Health Group HMO |
$98.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.63
|
| Rate for Payer: PHCS Commercial |
$125.81
|
| Rate for Payer: United Healthcare All Payer |
$115.32
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$56.65 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.65
|
| Rate for Payer: Anthem Medicaid |
$58.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$726.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$195.09
|
| Rate for Payer: Healthspan PPO |
$150.63
|
| Rate for Payer: Humana Medicaid |
$58.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.71
|
| Rate for Payer: Molina Healthcare Passport |
$58.54
|
| Rate for Payer: Multiplan PHCS |
$435.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$508.20
|
| Rate for Payer: UHCCP Medicaid |
$59.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.13
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.06
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
INGEST CHALLENGE INI 120 MIN
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
92200019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem Medicaid |
$249.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Humana KY Medicaid |
$249.67
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$252.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.06
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
INGEST CHALLENGE INI 120 MI(T
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
922T0019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.06
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
INGEST CHALLENGE INI 120 MI(T
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
HCPCS 95076
|
| Hospital Charge Code |
922T0019
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$94.38 |
| Max. Negotiated Rate |
$696.96 |
| Rate for Payer: Aetna Commercial |
$559.02
|
| Rate for Payer: Anthem Medicaid |
$249.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$566.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna Commercial |
$602.58
|
| Rate for Payer: First Health Commercial |
$689.70
|
| Rate for Payer: Humana Commercial |
$617.10
|
| Rate for Payer: Humana KY Medicaid |
$249.67
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$252.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$595.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.88
|
| Rate for Payer: Ohio Health Group HMO |
$544.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$225.06
|
| Rate for Payer: PHCS Commercial |
$696.96
|
| Rate for Payer: United Healthcare All Payer |
$638.88
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$17,027.92
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$11,554.66 |
| Max. Negotiated Rate |
$17,027.92 |
| Rate for Payer: Anthem Medicaid |
$11,554.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,162.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,027.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,419.78
|
| Rate for Payer: Humana KY Medicaid |
$11,554.66
|
| Rate for Payer: Humana Medicare Advantage |
$12,162.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,670.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,595.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,785.75
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$28,075.70
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$19,051.37 |
| Max. Negotiated Rate |
$28,075.70 |
| Rate for Payer: Anthem Medicaid |
$19,051.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,054.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,075.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,072.99
|
| Rate for Payer: Humana KY Medicaid |
$19,051.37
|
| Rate for Payer: Humana Medicare Advantage |
$20,054.07
|
| Rate for Payer: Kentucky WC Medicaid |
$19,241.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,064.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,432.39
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,973.32
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$8,803.33 |
| Max. Negotiated Rate |
$12,973.32 |
| Rate for Payer: Anthem Medicaid |
$8,803.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,266.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,973.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,509.99
|
| Rate for Payer: Humana KY Medicaid |
$8,803.33
|
| Rate for Payer: Humana Medicare Advantage |
$9,266.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,891.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,119.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,979.39
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Professional
|
Both
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5,409.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$5,409.50
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,245.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,786.65
|
| Rate for Payer: UHCCP Medicaid |
$1,893.32
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Facility
|
IP
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.24 |
| Max. Negotiated Rate |
$5,193.12 |
| Rate for Payer: Aetna Commercial |
$4,165.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.41
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cigna Commercial |
$4,489.88
|
| Rate for Payer: First Health Commercial |
$5,139.02
|
| Rate for Payer: Humana Commercial |
$4,598.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.94
|
| Rate for Payer: PHCS Commercial |
$5,193.12
|
| Rate for Payer: United Healthcare All Payer |
$4,760.36
|
|
|
INGUINAL LYMPH NODE BIOPSY
|
Facility
|
OP
|
$5,409.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
76101614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.39 |
| Max. Negotiated Rate |
$5,193.12 |
| Rate for Payer: Aetna Commercial |
$4,165.32
|
| Rate for Payer: Anthem Medicaid |
$1,860.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$375.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,219.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$525.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$506.78
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cash Price |
$2,704.75
|
| Rate for Payer: Cigna Commercial |
$4,489.88
|
| Rate for Payer: First Health Commercial |
$5,139.02
|
| Rate for Payer: Humana Commercial |
$4,598.08
|
| Rate for Payer: Humana KY Medicaid |
$1,860.33
|
| Rate for Payer: Humana Medicare Advantage |
$375.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,992.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,760.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,057.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.94
|
| Rate for Payer: PHCS Commercial |
$5,193.12
|
| Rate for Payer: United Healthcare All Payer |
$4,760.36
|
|
|
INGUINAL LYMPH NODE BIOPSY(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761P1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
|
|
INGUINAL LYMPH NODE BIOPSY(T
|
Facility
|
IP
|
$4,759.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761T1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.74 |
| Max. Negotiated Rate |
$4,569.12 |
| Rate for Payer: Aetna Commercial |
$3,664.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.41
|
| Rate for Payer: Cash Price |
$2,379.75
|
| Rate for Payer: Cigna Commercial |
$3,950.38
|
| Rate for Payer: First Health Commercial |
$4,521.52
|
| Rate for Payer: Humana Commercial |
$4,045.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,902.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,569.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,475.44
|
| Rate for Payer: PHCS Commercial |
$4,569.12
|
| Rate for Payer: United Healthcare All Payer |
$4,188.36
|
|
|
INGUINAL LYMPH NODE BIOPSY(T
|
Facility
|
OP
|
$4,759.50
|
|
|
Service Code
|
HCPCS 38999
|
| Hospital Charge Code |
761T1614
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.39 |
| Max. Negotiated Rate |
$4,569.12 |
| Rate for Payer: Aetna Commercial |
$3,664.82
|
| Rate for Payer: Anthem Medicaid |
$1,636.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$375.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$525.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$506.78
|
| Rate for Payer: Cash Price |
$2,379.75
|
| Rate for Payer: Cash Price |
$2,379.75
|
| Rate for Payer: Cigna Commercial |
$3,950.38
|
| Rate for Payer: First Health Commercial |
$4,521.52
|
| Rate for Payer: Humana Commercial |
$4,045.58
|
| Rate for Payer: Humana KY Medicaid |
$1,636.79
|
| Rate for Payer: Humana Medicare Advantage |
$375.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,902.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,569.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,475.44
|
| Rate for Payer: PHCS Commercial |
$4,569.12
|
| Rate for Payer: United Healthcare All Payer |
$4,188.36
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| 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: 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 |
$448.50
|
| 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
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Anthem Medicaid |
$2,800.00
|
| 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: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$2,800.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,856.00
|
| Rate for Payer: Molina Healthcare Passport |
$2,800.00
|
| 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 |
$2,828.00
|
|
|
INGUIN EX W/ILIOG/ILIOHY NEUR
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64999
|
| Hospital Charge Code |
76102879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| 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 |
$256.12
|
| 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 |
$307.34
|
| 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
|
|
