|
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 BUPIVICAINE HYDRO 30ML
|
Professional
|
Both
|
$97.54
|
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$97.54 |
| Rate for Payer: Buckeye Medicare Advantage |
$97.54
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Multiplan PHCS |
$58.52
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.28
|
| Rate for Payer: UHCCP Medicaid |
$34.14
|
|
|
INJ BUPIVICAINE HYDRO 30ML
|
Facility
|
OP
|
$97.54
|
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$75.11
|
| Rate for Payer: Anthem Medicaid |
$33.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.08
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: First Health Commercial |
$92.66
|
| Rate for Payer: Humana Commercial |
$82.91
|
| Rate for Payer: Humana KY Medicaid |
$33.54
|
| Rate for Payer: Kentucky WC Medicaid |
$33.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.84
|
| Rate for Payer: Ohio Health Group HMO |
$73.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.24
|
| Rate for Payer: PHCS Commercial |
$93.64
|
| Rate for Payer: United Healthcare All Payer |
$85.84
|
|
|
INJ BUPIVICAINE HYDRO 30ML
|
Facility
|
IP
|
$97.54
|
|
| Hospital Charge Code |
636T0119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$75.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.08
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: First Health Commercial |
$92.66
|
| Rate for Payer: Humana Commercial |
$82.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.84
|
| Rate for Payer: Ohio Health Group HMO |
$73.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.24
|
| Rate for Payer: PHCS Commercial |
$93.64
|
| Rate for Payer: United Healthcare All Payer |
$85.84
|
|
|
INJ BUPIVICAINE HYDRO 30ML
|
Facility
|
OP
|
$97.54
|
|
| Hospital Charge Code |
636T0119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$75.11
|
| Rate for Payer: Anthem Medicaid |
$33.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.08
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: First Health Commercial |
$92.66
|
| Rate for Payer: Humana Commercial |
$82.91
|
| Rate for Payer: Humana KY Medicaid |
$33.54
|
| Rate for Payer: Kentucky WC Medicaid |
$33.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.84
|
| Rate for Payer: Ohio Health Group HMO |
$73.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.24
|
| Rate for Payer: PHCS Commercial |
$93.64
|
| Rate for Payer: United Healthcare All Payer |
$85.84
|
|
|
INJ BUPIVICAINE HYDRO 30ML
|
Facility
|
IP
|
$97.54
|
|
| Hospital Charge Code |
63600119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$75.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.08
|
| Rate for Payer: Cash Price |
$48.77
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: First Health Commercial |
$92.66
|
| Rate for Payer: Humana Commercial |
$82.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$85.84
|
| Rate for Payer: Ohio Health Group HMO |
$73.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.24
|
| Rate for Payer: PHCS Commercial |
$93.64
|
| Rate for Payer: United Healthcare All Payer |
$85.84
|
|
|
INJECTAFER 1MG [750MG/15ML VL]
|
Facility
|
OP
|
$3,179.70
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
25002057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$3,052.51 |
| Rate for Payer: Aetna Commercial |
$2,448.37
|
| Rate for Payer: Anthem Medicaid |
$1,093.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.55
|
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Cigna Commercial |
$2,639.15
|
| Rate for Payer: First Health Commercial |
$3,020.72
|
| Rate for Payer: Humana Commercial |
$2,702.74
|
| Rate for Payer: Humana KY Medicaid |
$1,093.50
|
| Rate for Payer: Humana Medicare Advantage |
$1.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.71
|
| Rate for Payer: PHCS Commercial |
$3,052.51
|
| Rate for Payer: United Healthcare All Payer |
$2,798.14
|
|
|
INJECTAFER 1MG [750MG/15ML VL]
|
Facility
|
IP
|
$3,179.70
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
25002057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$413.36 |
| Max. Negotiated Rate |
$3,052.51 |
| Rate for Payer: Aetna Commercial |
$2,448.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.17
|
| Rate for Payer: Cash Price |
$1,589.85
|
| Rate for Payer: Cigna Commercial |
$2,639.15
|
| Rate for Payer: First Health Commercial |
$3,020.72
|
| Rate for Payer: Humana Commercial |
$2,702.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$635.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.71
|
| Rate for Payer: PHCS Commercial |
$3,052.51
|
| Rate for Payer: United Healthcare All Payer |
$2,798.14
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
76102488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.47
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
76102488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem Medicaid |
$115.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Humana KY Medicaid |
$115.89
|
| Rate for Payer: Kentucky WC Medicaid |
$117.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.47
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem Medicaid |
$115.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Humana KY Medicaid |
$115.89
|
| Rate for Payer: Kentucky WC Medicaid |
$117.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.47
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.47
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECTION ANES AGENT/STEROID
|
Facility
|
OP
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.40 |
| Max. Negotiated Rate |
$1,383.84 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: Anthem Medicaid |
$495.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,124.37
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$1,196.44
|
| Rate for Payer: First Health Commercial |
$1,369.42
|
| Rate for Payer: Humana Commercial |
$1,225.28
|
| Rate for Payer: Humana KY Medicaid |
$495.73
|
| Rate for Payer: Kentucky WC Medicaid |
$500.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,182.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,081.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.86
|
| Rate for Payer: PHCS Commercial |
$1,383.84
|
| Rate for Payer: United Healthcare All Payer |
$1,268.52
|
|
|
INJECTION ANES AGENT/STEROID
|
Facility
|
IP
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.40 |
| Max. Negotiated Rate |
$1,383.84 |
| Rate for Payer: Aetna Commercial |
$1,109.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,124.37
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$1,196.44
|
| Rate for Payer: First Health Commercial |
$1,369.42
|
| Rate for Payer: Humana Commercial |
$1,225.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,182.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,081.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.86
|
| Rate for Payer: PHCS Commercial |
$1,383.84
|
| Rate for Payer: United Healthcare All Payer |
$1,268.52
|
|
|
INJECTION ANES AGENT/STEROID
|
Professional
|
Both
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$1,441.50 |
| Rate for Payer: Aetna Commercial |
$129.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.00
|
| Rate for Payer: Anthem Medicaid |
$145.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,441.50
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$159.37
|
| Rate for Payer: Healthspan PPO |
$166.74
|
| Rate for Payer: Humana Medicaid |
$145.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.40
|
| Rate for Payer: Molina Healthcare Passport |
$145.49
|
| Rate for Payer: Multiplan PHCS |
$864.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.05
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.94
|
|
|
INJECTION ANES AGENT/STEROID(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761P2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$129.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.00
|
| Rate for Payer: Anthem Medicaid |
$145.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$159.37
|
| Rate for Payer: Healthspan PPO |
$166.74
|
| Rate for Payer: Humana Medicaid |
$145.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.40
|
| Rate for Payer: Molina Healthcare Passport |
$145.49
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.50
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.94
|
|
|
INJECTION ANES AGENT/STEROID(T
|
Facility
|
IP
|
$1,176.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761T2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$1,129.44 |
| Rate for Payer: Aetna Commercial |
$905.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$917.67
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cigna Commercial |
$976.50
|
| Rate for Payer: First Health Commercial |
$1,117.68
|
| Rate for Payer: Humana Commercial |
$1,000.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$964.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$868.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,035.32
|
| Rate for Payer: Ohio Health Group HMO |
$882.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.72
|
| Rate for Payer: PHCS Commercial |
$1,129.44
|
| Rate for Payer: United Healthcare All Payer |
$1,035.32
|
|
|
INJECTION ANES AGENT/STEROID(T
|
Facility
|
OP
|
$1,176.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761T2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$1,129.44 |
| Rate for Payer: Aetna Commercial |
$905.90
|
| Rate for Payer: Anthem Medicaid |
$404.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$917.67
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cigna Commercial |
$976.50
|
| Rate for Payer: First Health Commercial |
$1,117.68
|
| Rate for Payer: Humana Commercial |
$1,000.02
|
| Rate for Payer: Humana KY Medicaid |
$404.60
|
| Rate for Payer: Kentucky WC Medicaid |
$408.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$964.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$868.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,035.32
|
| Rate for Payer: Ohio Health Group HMO |
$882.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.72
|
| Rate for Payer: PHCS Commercial |
$1,129.44
|
| Rate for Payer: United Healthcare All Payer |
$1,035.32
|
|
|
INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
|
Facility
|
OP
|
$1,103.49
|
|
|
Service Code
|
CPT 64520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$788.21 |
| Max. Negotiated Rate |
$1,103.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
|
|
INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
|
Facility
|
OP
|
$358.57
|
|
|
Service Code
|
CPT 64505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.12 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
OP
|
$1,500.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
76102313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.03 |
| Max. Negotiated Rate |
$1,440.24 |
| Rate for Payer: Aetna Commercial |
$1,155.19
|
| Rate for Payer: Anthem Medicaid |
$515.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cigna Commercial |
$1,245.21
|
| Rate for Payer: First Health Commercial |
$1,425.24
|
| Rate for Payer: Humana Commercial |
$1,275.21
|
| Rate for Payer: Humana KY Medicaid |
$515.94
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$521.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.08
|
| Rate for Payer: PHCS Commercial |
$1,440.24
|
| Rate for Payer: United Healthcare All Payer |
$1,320.22
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
IP
|
$1,500.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
76102313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.03 |
| Max. Negotiated Rate |
$1,440.24 |
| Rate for Payer: Aetna Commercial |
$1,155.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.20
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cigna Commercial |
$1,245.21
|
| Rate for Payer: First Health Commercial |
$1,425.24
|
| Rate for Payer: Humana Commercial |
$1,275.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.08
|
| Rate for Payer: PHCS Commercial |
$1,440.24
|
| Rate for Payer: United Healthcare All Payer |
$1,320.22
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
761P2313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$116.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.75
|
| Rate for Payer: Anthem Medicaid |
$45.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$217.27
|
| Rate for Payer: Healthspan PPO |
$159.64
|
| Rate for Payer: Humana Medicaid |
$45.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.89
|
| Rate for Payer: Molina Healthcare Passport |
$45.97
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$39.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.43
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
OP
|
$1,280.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
761T2313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$1,229.04 |
| Rate for Payer: Aetna Commercial |
$985.79
|
| Rate for Payer: Anthem Medicaid |
$440.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$640.12
|
| Rate for Payer: Cash Price |
$640.12
|
| Rate for Payer: Cigna Commercial |
$1,062.61
|
| Rate for Payer: First Health Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial |
$1,088.21
|
| Rate for Payer: Humana KY Medicaid |
$440.28
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.62
|
| Rate for Payer: Ohio Health Group HMO |
$960.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.88
|
| Rate for Payer: PHCS Commercial |
$1,229.04
|
| Rate for Payer: United Healthcare All Payer |
$1,126.62
|
|
