|
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
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(P
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761P2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$77.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.48
|
| Rate for Payer: Anthem Medicaid |
$42.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$86.36
|
| Rate for Payer: Healthspan PPO |
$162.28
|
| Rate for Payer: Humana Medicaid |
$42.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.28
|
| Rate for Payer: Molina Healthcare Passport |
$42.43
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.00
|
| Rate for Payer: UHCCP Medicaid |
$27.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.85
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(T
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761T2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem Medicaid |
$135.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Humana KY Medicaid |
$135.84
|
| Rate for Payer: Kentucky WC Medicaid |
$137.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(T
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761T2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
INJ SUPRAVALVULAR AORTOGRAPHY
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
76102490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$77.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.48
|
| Rate for Payer: Anthem Medicaid |
$42.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$86.36
|
| Rate for Payer: Healthspan PPO |
$162.28
|
| Rate for Payer: Humana Medicaid |
$42.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.28
|
| Rate for Payer: Molina Healthcare Passport |
$42.43
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$27.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.85
|
|
|
INJ SUPRAVALVULAR AORTOGRAPHY
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
76102490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
INJ SUPRAVALVULAR AORTOGRAPHY
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
INJ SUPRAVALVULAR AORTOGRAPHY
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
76102490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
INJ SUPRAVALVULAR AORTOGRAPHY
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem Medicaid |
$135.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Humana KY Medicaid |
$135.84
|
| Rate for Payer: Kentucky WC Medicaid |
$137.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
INJ TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.71
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
INJ TENDON ORIGIN/INSERTION
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Aetna Commercial |
$65.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.71
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.00
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$91.61
|
| Rate for Payer: Healthspan PPO |
$75.40
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$324.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$378.70
|
| Rate for Payer: UHCCP Medicaid |
$35.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
INJ TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem Medicaid |
$186.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Humana KY Medicaid |
$186.05
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$187.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.71
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
INJ TENDON ORIGIN/INSERTION(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
761P0338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$91.61 |
| Rate for Payer: Aetna Commercial |
$65.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.71
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$91.61
|
| Rate for Payer: Healthspan PPO |
$75.40
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$35.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
INJ TENDON ORIGIN/INSERTION(T
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
761T0338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem Medicaid |
$155.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Humana KY Medicaid |
$155.10
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
INJ TENDON ORIGIN/INSERTION(T
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 20551
|
| Hospital Charge Code |
761T0338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| 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 |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| 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 |
$256.12
|
| 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 |
$307.34
|
| 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
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem Medicaid |
$168.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Humana KY Medicaid |
$168.85
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$170.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.21
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$471.36 |
| Rate for Payer: Aetna Commercial |
$378.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.98
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$407.53
|
| Rate for Payer: First Health Commercial |
$466.45
|
| Rate for Payer: Humana Commercial |
$417.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.08
|
| Rate for Payer: Ohio Health Group HMO |
$368.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.21
|
| Rate for Payer: PHCS Commercial |
$471.36
|
| Rate for Payer: United Healthcare All Payer |
$432.08
|
|
|
INJ TRIGGER POINT 1/2 MUSCL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.11
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$491.00
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cash Price |
$245.50
|
| Rate for Payer: Cigna Commercial |
$85.59
|
| Rate for Payer: Healthspan PPO |
$67.79
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$294.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$343.70
|
| Rate for Payer: UHCCP Medicaid |
$29.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
INJ TRIGGER POINT 1/2 MUSCL(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
761P0339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$54.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.11
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$85.59
|
| Rate for Payer: Healthspan PPO |
$67.79
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$29.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
INJ TRIGGER POINT 1/2 MUSCL(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
761T0339
|
|
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 |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| 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 |
$256.12
|
| 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 |
$307.34
|
| 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
|
|
|
INJ TRIGGER POINT 1/2 MUSCL(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20552
|
| Hospital Charge Code |
761T0339
|
|
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
|
|
|
INNOVA 5*100*130 STENT
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem Medicaid |
$1,490.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Humana KY Medicaid |
$1,490.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,520.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 5*100*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
