|
INIT TX 1STDGR BURN NOOTH TX(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761T0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem Medicaid |
$167.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Humana KY Medicaid |
$167.48
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$169.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$31.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.00
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$31.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.57
|
| Rate for Payer: Molina Healthcare Passport |
$31.93
|
| Rate for Payer: Multiplan PHCS |
$292.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$340.90
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.25
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$31.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.00
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$31.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.57
|
| Rate for Payer: Molina Healthcare Passport |
$31.93
|
| Rate for Payer: Multiplan PHCS |
$292.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$340.90
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.25
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.31 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem Medicaid |
$167.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Humana KY Medicaid |
$167.48
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$169.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.97
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(P
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761P2847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$31.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$31.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.57
|
| Rate for Payer: Molina Healthcare Passport |
$31.93
|
| Rate for Payer: Multiplan PHCS |
$82.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.60
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.25
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(P
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761P0337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$31.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$31.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.57
|
| Rate for Payer: Molina Healthcare Passport |
$31.93
|
| Rate for Payer: Multiplan PHCS |
$82.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.60
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.25
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(T
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761T0337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(T
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761T0337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(T
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761T2847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(T
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761T2847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
INJ ANES LMBR/THRC PARAV SYM(P
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
761P2335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$122.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.38
|
| Rate for Payer: Anthem Medicaid |
$63.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$465.00
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$238.06
|
| Rate for Payer: Healthspan PPO |
$218.12
|
| Rate for Payer: Humana Medicaid |
$63.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.32
|
| Rate for Payer: Molina Healthcare Passport |
$63.06
|
| Rate for Payer: Multiplan PHCS |
$279.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$325.50
|
| Rate for Payer: UHCCP Medicaid |
$53.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.69
|
|
|
INJ ANES LMBR/THRC PARAV SYMP
|
Facility
|
OP
|
$2,517.50
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
76102335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.28 |
| Max. Negotiated Rate |
$2,416.80 |
| Rate for Payer: Aetna Commercial |
$1,938.48
|
| Rate for Payer: Anthem Medicaid |
$865.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,963.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,258.75
|
| Rate for Payer: Cash Price |
$1,258.75
|
| Rate for Payer: Cigna Commercial |
$2,089.52
|
| Rate for Payer: First Health Commercial |
$2,391.62
|
| Rate for Payer: Humana Commercial |
$2,139.88
|
| Rate for Payer: Humana KY Medicaid |
$865.77
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$874.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,857.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$883.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.42
|
| Rate for Payer: PHCS Commercial |
$2,416.80
|
| Rate for Payer: United Healthcare All Payer |
$2,215.40
|
|
|
INJ ANES LMBR/THRC PARAV SYMP
|
Facility
|
IP
|
$2,517.50
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
76102335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.28 |
| Max. Negotiated Rate |
$2,416.80 |
| Rate for Payer: Aetna Commercial |
$1,938.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,963.65
|
| Rate for Payer: Cash Price |
$1,258.75
|
| Rate for Payer: Cigna Commercial |
$2,089.52
|
| Rate for Payer: First Health Commercial |
$2,391.62
|
| Rate for Payer: Humana Commercial |
$2,139.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,064.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,857.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$755.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,215.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,888.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.42
|
| Rate for Payer: PHCS Commercial |
$2,416.80
|
| Rate for Payer: United Healthcare All Payer |
$2,215.40
|
|
|
INJ ANES LMBR/THRC PARAV SYMP
|
Professional
|
Both
|
$2,517.50
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
76102335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.38 |
| Max. Negotiated Rate |
$2,517.50 |
| Rate for Payer: Aetna Commercial |
$122.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.38
|
| Rate for Payer: Anthem Medicaid |
$63.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,517.50
|
| Rate for Payer: Cash Price |
$1,258.75
|
| Rate for Payer: Cash Price |
$1,258.75
|
| Rate for Payer: Cigna Commercial |
$238.06
|
| Rate for Payer: Healthspan PPO |
$218.12
|
| Rate for Payer: Humana Medicaid |
$63.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.32
|
| Rate for Payer: Molina Healthcare Passport |
$63.06
|
| Rate for Payer: Multiplan PHCS |
$1,510.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,762.25
|
| Rate for Payer: UHCCP Medicaid |
$53.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.69
|
|
|
INJ ANES LMBR/THRC PARAV SYM(T
|
Facility
|
OP
|
$2,052.50
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
761T2335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.82 |
| Max. Negotiated Rate |
$1,970.40 |
| Rate for Payer: Aetna Commercial |
$1,580.42
|
| Rate for Payer: Anthem Medicaid |
$705.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,026.25
|
| Rate for Payer: Cash Price |
$1,026.25
|
| Rate for Payer: Cigna Commercial |
$1,703.58
|
| Rate for Payer: First Health Commercial |
$1,949.88
|
| Rate for Payer: Humana Commercial |
$1,744.62
|
| Rate for Payer: Humana KY Medicaid |
$705.85
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$713.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.28
|
| Rate for Payer: PHCS Commercial |
$1,970.40
|
| Rate for Payer: United Healthcare All Payer |
$1,806.20
|
|
|
INJ ANES LMBR/THRC PARAV SYM(T
|
Facility
|
IP
|
$2,052.50
|
|
|
Service Code
|
HCPCS 64520
|
| Hospital Charge Code |
761T2335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.82 |
| Max. Negotiated Rate |
$1,970.40 |
| Rate for Payer: Aetna Commercial |
$1,580.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.95
|
| Rate for Payer: Cash Price |
$1,026.25
|
| Rate for Payer: Cigna Commercial |
$1,703.58
|
| Rate for Payer: First Health Commercial |
$1,949.88
|
| Rate for Payer: Humana Commercial |
$1,744.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$636.28
|
| Rate for Payer: PHCS Commercial |
$1,970.40
|
| Rate for Payer: United Healthcare All Payer |
$1,806.20
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
761T2319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem Medicaid |
$352.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Humana KY Medicaid |
$352.15
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$355.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.44
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
761T2319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.44
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
45000296
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.44
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
76102319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$1,415.04 |
| Rate for Payer: Aetna Commercial |
$1,134.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,149.72
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna Commercial |
$1,223.42
|
| Rate for Payer: First Health Commercial |
$1,400.30
|
| Rate for Payer: Humana Commercial |
$1,252.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,208.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,087.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.94
|
| Rate for Payer: PHCS Commercial |
$1,415.04
|
| Rate for Payer: United Healthcare All Payer |
$1,297.12
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
76102319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$1,415.04 |
| Rate for Payer: Aetna Commercial |
$1,134.98
|
| Rate for Payer: Anthem Medicaid |
$506.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,149.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna Commercial |
$1,223.42
|
| Rate for Payer: First Health Commercial |
$1,400.30
|
| Rate for Payer: Humana Commercial |
$1,252.90
|
| Rate for Payer: Humana KY Medicaid |
$506.91
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$512.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,208.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,087.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.94
|
| Rate for Payer: PHCS Commercial |
$1,415.04
|
| Rate for Payer: United Healthcare All Payer |
$1,297.12
|
|
|
INJ ANES PERIPHER NERVE BRANCH
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
45000296
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem Medicaid |
$352.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Humana KY Medicaid |
$352.15
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$355.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.44
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
