|
INJ PROC; LYMPHANGIOGRAPHY
|
Professional
|
Both
|
$3,309.89
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$3,309.89 |
| Rate for Payer: Aetna Commercial |
$124.40
|
| Rate for Payer: Anthem Medicaid |
$86.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,309.89
|
| Rate for Payer: Cash Price |
$1,654.94
|
| Rate for Payer: Cash Price |
$1,654.94
|
| Rate for Payer: Cigna Commercial |
$117.21
|
| Rate for Payer: Healthspan PPO |
$99.47
|
| Rate for Payer: Humana Medicaid |
$86.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.19
|
| Rate for Payer: Molina Healthcare Passport |
$86.46
|
| Rate for Payer: Multiplan PHCS |
$1,985.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,316.92
|
| Rate for Payer: UHCCP Medicaid |
$1,158.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.32
|
|
|
INJ PROC; LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$3,309.89
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.29 |
| Max. Negotiated Rate |
$3,177.49 |
| Rate for Payer: Aetna Commercial |
$2,548.62
|
| Rate for Payer: Anthem Medicaid |
$1,138.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.71
|
| Rate for Payer: Cash Price |
$1,654.94
|
| Rate for Payer: Cigna Commercial |
$2,747.21
|
| Rate for Payer: First Health Commercial |
$3,144.40
|
| Rate for Payer: Humana Commercial |
$2,813.41
|
| Rate for Payer: Humana KY Medicaid |
$1,138.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,714.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,161.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.07
|
| Rate for Payer: PHCS Commercial |
$3,177.49
|
| Rate for Payer: United Healthcare All Payer |
$2,912.70
|
|
|
INJ PROC; LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$3,309.89
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
76101611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.29 |
| Max. Negotiated Rate |
$3,177.49 |
| Rate for Payer: Aetna Commercial |
$2,548.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,581.71
|
| Rate for Payer: Cash Price |
$1,654.94
|
| Rate for Payer: Cigna Commercial |
$2,747.21
|
| Rate for Payer: First Health Commercial |
$3,144.40
|
| Rate for Payer: Humana Commercial |
$2,813.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,714.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,442.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,912.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,482.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.07
|
| Rate for Payer: PHCS Commercial |
$3,177.49
|
| Rate for Payer: United Healthcare All Payer |
$2,912.70
|
|
|
INJ PROC; LYMPHANGIOGRAPHY(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761P1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$124.40
|
| Rate for Payer: Anthem Medicaid |
$86.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$117.21
|
| Rate for Payer: Healthspan PPO |
$99.47
|
| Rate for Payer: Humana Medicaid |
$86.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.19
|
| Rate for Payer: Molina Healthcare Passport |
$86.46
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.32
|
|
|
INJ PROC; LYMPHANGIOGRAPHY(T
|
Facility
|
OP
|
$1,789.89
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761T1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.69 |
| Max. Negotiated Rate |
$1,718.29 |
| Rate for Payer: Aetna Commercial |
$1,378.22
|
| Rate for Payer: Anthem Medicaid |
$615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.11
|
| Rate for Payer: Cash Price |
$894.94
|
| Rate for Payer: Cigna Commercial |
$1,485.61
|
| Rate for Payer: First Health Commercial |
$1,700.40
|
| Rate for Payer: Humana Commercial |
$1,521.41
|
| Rate for Payer: Humana KY Medicaid |
$615.54
|
| Rate for Payer: Kentucky WC Medicaid |
$621.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,320.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.87
|
| Rate for Payer: PHCS Commercial |
$1,718.29
|
| Rate for Payer: United Healthcare All Payer |
$1,575.10
|
|
|
INJ PROC; LYMPHANGIOGRAPHY(T
|
Facility
|
IP
|
$1,789.89
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761T1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.69 |
| Max. Negotiated Rate |
$1,718.29 |
| Rate for Payer: Aetna Commercial |
$1,378.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.11
|
| Rate for Payer: Cash Price |
$894.94
|
| Rate for Payer: Cigna Commercial |
$1,485.61
|
| Rate for Payer: First Health Commercial |
$1,700.40
|
| Rate for Payer: Humana Commercial |
$1,521.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,320.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.87
|
| Rate for Payer: PHCS Commercial |
$1,718.29
|
| Rate for Payer: United Healthcare All Payer |
$1,575.10
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
|
|
INJ PROC SHOULDER ARTHROGRAM(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761P0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
|
|
INJ PROC SHOULDER ARTHROGRAM(T
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761T0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem Medicaid |
$221.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Humana KY Medicaid |
$221.82
|
| Rate for Payer: Kentucky WC Medicaid |
$224.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$226.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
INJ PROC SHOULDER ARTHROGRAM(T
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761T0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.85 |
| Max. Negotiated Rate |
$619.20 |
| Rate for Payer: Aetna Commercial |
$496.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$503.10
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$535.35
|
| Rate for Payer: First Health Commercial |
$612.75
|
| Rate for Payer: Humana Commercial |
$548.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$528.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$476.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$193.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$567.60
|
| Rate for Payer: Ohio Health Group HMO |
$483.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$199.95
|
| Rate for Payer: PHCS Commercial |
$619.20
|
| Rate for Payer: United Healthcare All Payer |
$567.60
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.75
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem Medicaid |
$490.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Humana KY Medicaid |
$490.06
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$495.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.75
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$151.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.95
|
| Rate for Payer: Anthem Medicaid |
$50.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.00
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$257.90
|
| Rate for Payer: Healthspan PPO |
$200.64
|
| Rate for Payer: Humana Medicaid |
$50.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.17
|
| Rate for Payer: Molina Healthcare Passport |
$50.17
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.50
|
| Rate for Payer: UHCCP Medicaid |
$60.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.67
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761P1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$151.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.95
|
| Rate for Payer: Anthem Medicaid |
$50.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$257.90
|
| Rate for Payer: Healthspan PPO |
$200.64
|
| Rate for Payer: Humana Medicaid |
$50.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.17
|
| Rate for Payer: Molina Healthcare Passport |
$50.17
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$60.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.67
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761T1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761T1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
48100076
|
|
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
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
76102489
|
|
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
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
48100076
|
|
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
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
76102489
|
|
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
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
45000295
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.57 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$761.53
|
| Rate for Payer: Anthem Medicaid |
$340.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$771.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cigna Commercial |
$820.87
|
| Rate for Payer: First Health Commercial |
$939.55
|
| Rate for Payer: Humana Commercial |
$840.65
|
| Rate for Payer: Humana KY Medicaid |
$340.12
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$343.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$346.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$870.32
|
| Rate for Payer: Ohio Health Group HMO |
$741.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.59
|
| Rate for Payer: PHCS Commercial |
$949.44
|
| Rate for Payer: United Healthcare All Payer |
$870.32
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
76102573
|
|
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
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
45000295
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.57 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$761.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$771.42
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cigna Commercial |
$820.87
|
| Rate for Payer: First Health Commercial |
$939.55
|
| Rate for Payer: Humana Commercial |
$840.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$870.32
|
| Rate for Payer: Ohio Health Group HMO |
$741.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.59
|
| Rate for Payer: PHCS Commercial |
$949.44
|
| Rate for Payer: United Healthcare All Payer |
$870.32
|
|
