|
INGUINOFEMORAL LYMPHADENECTOMY
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.96 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,230.90
|
| Rate for Payer: Anthem Medicaid |
$450.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,149.46
|
| Rate for Payer: Healthspan PPO |
$984.22
|
| Rate for Payer: Humana Medicaid |
$450.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,078.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.98
|
| Rate for Payer: Molina Healthcare Passport |
$450.96
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.47
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
761P1609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.96 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,230.90
|
| Rate for Payer: Anthem Medicaid |
$450.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,350.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,149.46
|
| Rate for Payer: Healthspan PPO |
$984.22
|
| Rate for Payer: Humana Medicaid |
$450.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,078.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.98
|
| Rate for Payer: Molina Healthcare Passport |
$450.96
|
| Rate for Payer: Multiplan PHCS |
$810.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$945.00
|
| Rate for Payer: UHCCP Medicaid |
$472.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.47
|
|
|
INGUINOFEMORAL LYMPHADENECTOMY
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS 38760
|
| Hospital Charge Code |
76101609
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Anthem Medicaid |
$464.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,053.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$1,120.50
|
| Rate for Payer: First Health Commercial |
$1,282.50
|
| Rate for Payer: Humana Commercial |
$1,147.50
|
| Rate for Payer: Humana KY Medicaid |
$464.26
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$468.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,107.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$996.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$473.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,188.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$418.50
|
| Rate for Payer: PHCS Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare All Payer |
$1,188.00
|
|
|
INHIBIN B S
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$11.52
|
| Rate for Payer: Healthspan PPO |
$13.57
|
| Rate for Payer: Multiplan PHCS |
$63.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$74.20
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.36
|
|
|
INHIBIN B S
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.27
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Humana KY Medicaid |
$17.27
|
| Rate for Payer: Humana Medicare Advantage |
$17.27
|
| Rate for Payer: Kentucky WC Medicaid |
$17.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.86
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
INHIBIN B S
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
30001799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.12
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$87.98
|
| Rate for Payer: First Health Commercial |
$100.70
|
| Rate for Payer: Humana Commercial |
$90.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$93.28
|
| Rate for Payer: Ohio Health Group HMO |
$79.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.86
|
| Rate for Payer: PHCS Commercial |
$101.76
|
| Rate for Payer: United Healthcare All Payer |
$93.28
|
|
|
INH (ISONIAZID) 300 300MG/1TAB
|
Facility
|
IP
|
$9.03
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
25000781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.58
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.95
|
| Rate for Payer: Ohio Health Group HMO |
$6.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.67
|
| Rate for Payer: United Healthcare All Payer |
$7.95
|
|
|
INH (ISONIAZID) 300 300MG/1TAB
|
Facility
|
OP
|
$9.03
|
|
|
Service Code
|
NDC 51079008320
|
| Hospital Charge Code |
25000781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.67 |
| Rate for Payer: Aetna Commercial |
$6.95
|
| Rate for Payer: Anthem Medicaid |
$3.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.04
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cigna Commercial |
$7.49
|
| Rate for Payer: First Health Commercial |
$8.58
|
| Rate for Payer: Humana Commercial |
$7.68
|
| Rate for Payer: Humana KY Medicaid |
$3.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.95
|
| Rate for Payer: Ohio Health Group HMO |
$6.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.80
|
| Rate for Payer: PHCS Commercial |
$8.67
|
| Rate for Payer: United Healthcare All Payer |
$7.95
|
|
|
INIT HOSPITAL CARE LEVEL 1
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
51000011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$142.42 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Anthem Medicaid |
$51.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$130.22
|
| Rate for Payer: Healthspan PPO |
$105.87
|
| Rate for Payer: Humana Medicaid |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.69
|
| Rate for Payer: Molina Healthcare Passport |
$51.66
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.18
|
|
|
INIT HOSPITAL CARE LEVEL 1(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99221
|
| Hospital Charge Code |
510P0011
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$142.42 |
| Rate for Payer: Aetna Commercial |
$142.42
|
| Rate for Payer: Anthem Medicaid |
$51.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$130.22
|
| Rate for Payer: Healthspan PPO |
$105.87
|
| Rate for Payer: Humana Medicaid |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.69
|
| Rate for Payer: Molina Healthcare Passport |
$51.66
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.18
|
|
|
INIT HOSPITAL CARE LEVEL 2
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
51000012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$194.52
|
| Rate for Payer: Anthem Medicaid |
$85.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$182.25
|
| Rate for Payer: Healthspan PPO |
$144.60
|
| Rate for Payer: Humana Medicaid |
$85.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.31
|
| Rate for Payer: Molina Healthcare Passport |
$85.60
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: United Healthcare Non-Options |
$133.97
|
| Rate for Payer: United Healthcare Options |
$109.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.46
|
|
|
INIT HOSPITAL CARE LEVEL 2(P
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99222
|
| Hospital Charge Code |
510P0012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$194.52
|
| Rate for Payer: Anthem Medicaid |
$85.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$210.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$182.25
|
| Rate for Payer: Healthspan PPO |
$144.60
|
| Rate for Payer: Humana Medicaid |
$85.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.31
|
| Rate for Payer: Molina Healthcare Passport |
$85.60
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
| Rate for Payer: United Healthcare Non-Options |
$133.97
|
| Rate for Payer: United Healthcare Options |
$109.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.46
|
|
|
INIT HOSPITAL CARE LEVEL 3
|
Professional
|
Both
|
$400.05
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
51000013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$400.05 |
| Rate for Payer: Aetna Commercial |
$285.83
|
| Rate for Payer: Anthem Medicaid |
$119.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.05
|
| Rate for Payer: Cash Price |
$200.02
|
| Rate for Payer: Cash Price |
$200.02
|
| Rate for Payer: Cigna Commercial |
$266.01
|
| Rate for Payer: Healthspan PPO |
$212.47
|
| Rate for Payer: Humana Medicaid |
$119.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$266.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.64
|
| Rate for Payer: Molina Healthcare Passport |
$119.25
|
| Rate for Payer: Multiplan PHCS |
$240.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.04
|
| Rate for Payer: UHCCP Medicaid |
$140.02
|
| Rate for Payer: United Healthcare Non-Options |
$196.85
|
| Rate for Payer: United Healthcare Options |
$161.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.44
|
|
|
INIT HOSPITAL CARE LEVEL 3(P
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 99223
|
| Hospital Charge Code |
510P0013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$295.00 |
| Rate for Payer: Aetna Commercial |
$285.83
|
| Rate for Payer: Anthem Medicaid |
$119.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.00
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cigna Commercial |
$266.01
|
| Rate for Payer: Healthspan PPO |
$212.47
|
| Rate for Payer: Humana Medicaid |
$119.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$266.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.64
|
| Rate for Payer: Molina Healthcare Passport |
$119.25
|
| Rate for Payer: Multiplan PHCS |
$177.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$206.50
|
| Rate for Payer: UHCCP Medicaid |
$103.25
|
| Rate for Payer: United Healthcare Non-Options |
$196.85
|
| Rate for Payer: United Healthcare Options |
$161.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.44
|
|
|
INITIAL FOOT EXAM PT LOPS
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
51000341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
51000341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.48
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
|
|
INITIAL FOOT EXAM PT LOPS
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
51000341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
INITIAL FOOT EXAM PT LOPS (P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
510P0341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.48
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
|
|
INITIAL FOOT EXAM PT LOPS(T
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
510T0341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$82.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$82.54
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$83.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
INITIAL FOOT EXAM PT LOPS(T
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS G0245
|
| Hospital Charge Code |
510T0341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.20
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
510P0142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.94
|
| Rate for Payer: Anthem Medicaid |
$20.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Humana Medicaid |
$20.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
51000142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.98
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
INITIAL PREVENTIVE EXAM
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
51000142
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
50000187
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$144.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.69
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
|
