|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem Medicaid |
$744.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Humana KY Medicaid |
$744.89
|
| Rate for Payer: Kentucky WC Medicaid |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$433.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.46
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
IP
|
$2,516.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
76102491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.08 |
| Max. Negotiated Rate |
$2,415.36 |
| Rate for Payer: Aetna Commercial |
$1,937.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,962.48
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cigna Commercial |
$2,088.28
|
| Rate for Payer: First Health Commercial |
$2,390.20
|
| Rate for Payer: Humana Commercial |
$2,138.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.96
|
| Rate for Payer: PHCS Commercial |
$2,415.36
|
| Rate for Payer: United Healthcare All Payer |
$2,214.08
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,516.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
76102491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.08 |
| Max. Negotiated Rate |
$2,415.36 |
| Rate for Payer: Aetna Commercial |
$1,937.32
|
| Rate for Payer: Anthem Medicaid |
$865.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,962.48
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cigna Commercial |
$2,088.28
|
| Rate for Payer: First Health Commercial |
$2,390.20
|
| Rate for Payer: Humana Commercial |
$2,138.60
|
| Rate for Payer: Humana KY Medicaid |
$865.25
|
| Rate for Payer: Kentucky WC Medicaid |
$874.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$327.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.96
|
| Rate for Payer: PHCS Commercial |
$2,415.36
|
| Rate for Payer: United Healthcare All Payer |
$2,214.08
|
|
|
INJECT PULM ART HRT CATH(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761P2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$70.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.23
|
| Rate for Payer: Anthem Medicaid |
$38.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$78.50
|
| Rate for Payer: Healthspan PPO |
$177.26
|
| Rate for Payer: Humana Medicaid |
$38.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.34
|
| Rate for Payer: Molina Healthcare Passport |
$38.57
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$25.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$38.96
|
|
|
INJECT PULM ART HRT CATH(T
|
Facility
|
OP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761T2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem Medicaid |
$744.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Humana KY Medicaid |
$744.89
|
| Rate for Payer: Kentucky WC Medicaid |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$433.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.46
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
INJECT PULM ART HRT CATH(T
|
Facility
|
IP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761T2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.58 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$433.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.46
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
INJECT R VENTR/ATRIAL ANGIO
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
48000097
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
INJECT R VENTR/ATRIAL ANGIO
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
48000097
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
OP
|
$1,828.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.64 |
| Max. Negotiated Rate |
$1,754.88 |
| Rate for Payer: Aetna Commercial |
$1,407.56
|
| Rate for Payer: Anthem Medicaid |
$628.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.84
|
| Rate for Payer: Cash Price |
$914.00
|
| Rate for Payer: Cigna Commercial |
$1,517.24
|
| Rate for Payer: First Health Commercial |
$1,736.60
|
| Rate for Payer: Humana Commercial |
$1,553.80
|
| Rate for Payer: Humana KY Medicaid |
$628.65
|
| Rate for Payer: Kentucky WC Medicaid |
$635.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.68
|
| Rate for Payer: PHCS Commercial |
$1,754.88
|
| Rate for Payer: United Healthcare All Payer |
$1,608.64
|
|
|
INJECT SACROILIAC JOINT
|
Professional
|
Both
|
$1,828.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$292.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,828.00
|
| Rate for Payer: Cash Price |
$914.00
|
| Rate for Payer: Cash Price |
$914.00
|
| Rate for Payer: Cigna Commercial |
$331.08
|
| Rate for Payer: Healthspan PPO |
$223.81
|
| Rate for Payer: Humana Medicaid |
$292.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.93
|
| Rate for Payer: Molina Healthcare Passport |
$292.09
|
| Rate for Payer: Multiplan PHCS |
$1,096.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,279.60
|
| Rate for Payer: UHCCP Medicaid |
$65.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.01
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
IP
|
$1,828.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.64 |
| Max. Negotiated Rate |
$1,754.88 |
| Rate for Payer: Aetna Commercial |
$1,407.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.84
|
| Rate for Payer: Cash Price |
$914.00
|
| Rate for Payer: Cigna Commercial |
$1,517.24
|
| Rate for Payer: First Health Commercial |
$1,736.60
|
| Rate for Payer: Humana Commercial |
$1,553.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,608.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$566.68
|
| Rate for Payer: PHCS Commercial |
$1,754.88
|
| Rate for Payer: United Healthcare All Payer |
$1,608.64
|
|
|
INJECT SACROILIAC JOINT(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
761P0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$292.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$331.08
|
| Rate for Payer: Healthspan PPO |
$223.81
|
| Rate for Payer: Humana Medicaid |
$292.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.93
|
| Rate for Payer: Molina Healthcare Passport |
$292.09
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$65.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.01
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$1,159.68 |
| Rate for Payer: Aetna Commercial |
$930.16
|
| Rate for Payer: Anthem Medicaid |
$415.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cigna Commercial |
$1,002.64
|
| Rate for Payer: First Health Commercial |
$1,147.60
|
| Rate for Payer: Humana Commercial |
$1,026.80
|
| Rate for Payer: Humana KY Medicaid |
$415.43
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$419.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$990.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$891.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.04
|
| Rate for Payer: Ohio Health Group HMO |
$906.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.48
|
| Rate for Payer: PHCS Commercial |
$1,159.68
|
| Rate for Payer: United Healthcare All Payer |
$1,063.04
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$1,159.68 |
| Rate for Payer: Aetna Commercial |
$930.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.24
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cigna Commercial |
$1,002.64
|
| Rate for Payer: First Health Commercial |
$1,147.60
|
| Rate for Payer: Humana Commercial |
$1,026.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$990.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$891.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.04
|
| Rate for Payer: Ohio Health Group HMO |
$906.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.48
|
| Rate for Payer: PHCS Commercial |
$1,159.68
|
| Rate for Payer: United Healthcare All Payer |
$1,063.04
|
|
|
INJECT SKIN LESIONS >7
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.73 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem Medicaid |
$144.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Humana KY Medicaid |
$144.78
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.51
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
INJECT SKIN LESIONS >7
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.15
|
| Rate for Payer: Anthem Medicaid |
$29.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.00
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$88.61
|
| Rate for Payer: Healthspan PPO |
$78.44
|
| Rate for Payer: Humana Medicaid |
$29.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.29
|
| Rate for Payer: Molina Healthcare Passport |
$29.70
|
| Rate for Payer: Multiplan PHCS |
$252.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.70
|
| Rate for Payer: UHCCP Medicaid |
$34.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.00
|
|
|
INJECT SKIN LESIONS >7
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.73 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.51
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
INJECT SKIN LESIONS >7(P
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761P0108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.15
|
| Rate for Payer: Anthem Medicaid |
$29.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$88.61
|
| Rate for Payer: Healthspan PPO |
$78.44
|
| Rate for Payer: Humana Medicaid |
$29.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.29
|
| Rate for Payer: Molina Healthcare Passport |
$29.70
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$34.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.00
|
|
|
INJECT SKIN LESIONS >7(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761T0108
|
|
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 Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| 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: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| 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 |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| 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
|
|
|
INJECT SKIN LESIONS >7(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761T0108
|
|
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
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
INJECT SKIN LESIONS </W 7
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.76
|
| Rate for Payer: Anthem Medicaid |
$19.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.00
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$69.71
|
| Rate for Payer: Healthspan PPO |
$61.52
|
| Rate for Payer: Humana Medicaid |
$19.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.48
|
| Rate for Payer: Molina Healthcare Passport |
$19.10
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.70
|
| Rate for Payer: UHCCP Medicaid |
$20.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.29
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
INJECT SKIN LESIONS </W 7(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
761P0107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.76
|
| Rate for Payer: Anthem Medicaid |
$19.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$69.71
|
| Rate for Payer: Healthspan PPO |
$61.52
|
| Rate for Payer: Humana Medicaid |
$19.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.48
|
| Rate for Payer: Molina Healthcare Passport |
$19.10
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$20.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.29
|
|
|
INJECT SKIN LESIONS </W 7(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
761T0107
|
|
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
|
|
