|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$998.60
|
| 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: 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 |
$384.08
|
| 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
|
|
|
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
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$53.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.90
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$53.30
|
| Rate for Payer: Kentucky WC Medicaid |
$53.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna Commercial |
$79.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.39
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$200.32
|
| Rate for Payer: Humana Medicaid |
$43.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.20
|
| Rate for Payer: Molina Healthcare Passport |
$43.33
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.50
|
| Rate for Payer: UHCCP Medicaid |
$40.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.76
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.90
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.05
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
INJECTION ANKLE ARTHROGRAPHY(P
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
761P0905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna Commercial |
$79.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.39
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$200.32
|
| Rate for Payer: Humana Medicaid |
$43.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.20
|
| Rate for Payer: Molina Healthcare Passport |
$43.33
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.50
|
| Rate for Payer: UHCCP Medicaid |
$40.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.76
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.60
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$108.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.81
|
| Rate for Payer: Anthem Medicaid |
$53.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$292.70
|
| Rate for Payer: Healthspan PPO |
$217.64
|
| Rate for Payer: Humana Medicaid |
$53.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.40
|
| Rate for Payer: Molina Healthcare Passport |
$53.33
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$46.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.86
|
|
|
INJECTION ELBOW ARTHROGRAPHY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761P0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$108.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.81
|
| Rate for Payer: Anthem Medicaid |
$53.33
|
| 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 |
$292.70
|
| Rate for Payer: Healthspan PPO |
$217.64
|
| Rate for Payer: Humana Medicaid |
$53.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.40
|
| Rate for Payer: Molina Healthcare Passport |
$53.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$46.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.86
|
|
|
INJECTION ELBOW ARTHROGRAPHY(T
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761T0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INJECTION ELBOW ARTHROGRAPHY(T
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761T0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761T2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Humana KY Medicaid |
$312.61
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$315.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
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
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761P2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.65
|
| Rate for Payer: Anthem Medicaid |
$43.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$89.26
|
| Rate for Payer: Humana Medicaid |
$43.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.02
|
| Rate for Payer: Molina Healthcare Passport |
$43.16
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.59
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761T2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.79
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
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
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.65
|
| Rate for Payer: Anthem Medicaid |
$43.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,024.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$89.26
|
| Rate for Payer: Humana Medicaid |
$43.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.02
|
| Rate for Payer: Molina Healthcare Passport |
$43.16
|
| Rate for Payer: Multiplan PHCS |
$614.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.80
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.59
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem Medicaid |
$328.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Humana KY Medicaid |
$328.42
|
| Rate for Payer: Kentucky WC Medicaid |
$331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
INJECTION FOR BLADDER X-RAY
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.19
|
| Rate for Payer: Anthem Medicaid |
$54.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$93.67
|
| Rate for Payer: Healthspan PPO |
$138.47
|
| Rate for Payer: Humana Medicaid |
$54.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.47
|
| Rate for Payer: Molina Healthcare Passport |
$54.38
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.50
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.92
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.69
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
INJECTION FOR BLADDER X-RAY
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$599.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.00
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$359.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.30
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem Medicaid |
$206.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Humana KY Medicaid |
$206.00
|
| Rate for Payer: Kentucky WC Medicaid |
$208.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.69
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJECTION FOR BLADDER X-RAY (P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761P2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.19
|
| Rate for Payer: Anthem Medicaid |
$54.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$93.67
|
| Rate for Payer: Healthspan PPO |
$138.47
|
| Rate for Payer: Humana Medicaid |
$54.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.47
|
| Rate for Payer: Molina Healthcare Passport |
$54.38
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.92
|
|
