|
INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
76102488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.10 |
| 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 |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
76102488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.10 |
| 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 |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECT CONGENITAL CARD CATH
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93563
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$101.10 |
| 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 |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJECTION ANES AGENT/STEROID
|
Facility
|
IP
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.45 |
| Max. Negotiated Rate |
$1,383.84 |
| Rate for Payer: Aetna Commercial |
$1,109.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,124.37
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$1,196.44
|
| Rate for Payer: First Health Commercial |
$1,369.42
|
| Rate for Payer: Humana Commercial |
$1,225.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,182.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,081.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,153.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,254.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$994.63
|
| Rate for Payer: PHCS Commercial |
$1,383.84
|
| Rate for Payer: United Healthcare All Payer |
$1,268.52
|
|
|
INJECTION ANES AGENT/STEROID
|
Professional
|
Both
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$864.90 |
| Rate for Payer: Aetna Commercial |
$129.16
|
| Rate for Payer: Ambetter Exchange |
$58.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.00
|
| Rate for Payer: Anthem Medicaid |
$145.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.78
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$159.37
|
| Rate for Payer: Healthspan PPO |
$166.74
|
| Rate for Payer: Humana Medicaid |
$145.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.40
|
| Rate for Payer: Molina Healthcare Passport |
$145.49
|
| Rate for Payer: Multiplan PHCS |
$864.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.59
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.15
|
|
|
INJECTION ANES AGENT/STEROID
|
Facility
|
OP
|
$1,441.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
76102322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.45 |
| Max. Negotiated Rate |
$1,383.84 |
| Rate for Payer: Aetna Commercial |
$1,109.95
|
| Rate for Payer: Anthem Medicaid |
$495.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,124.37
|
| Rate for Payer: Cash Price |
$720.75
|
| Rate for Payer: Cigna Commercial |
$1,196.44
|
| Rate for Payer: First Health Commercial |
$1,369.42
|
| Rate for Payer: Humana Commercial |
$1,225.28
|
| Rate for Payer: Humana KY Medicaid |
$495.73
|
| Rate for Payer: Kentucky WC Medicaid |
$500.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,182.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,081.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,153.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,254.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$994.63
|
| Rate for Payer: PHCS Commercial |
$1,383.84
|
| Rate for Payer: United Healthcare All Payer |
$1,268.52
|
|
|
INJECTION ANES AGENT/STEROID(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761P2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$129.16
|
| Rate for Payer: Ambetter Exchange |
$58.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.00
|
| Rate for Payer: Anthem Medicaid |
$145.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$58.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$58.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$69.78
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$159.37
|
| Rate for Payer: Healthspan PPO |
$166.74
|
| Rate for Payer: Humana Medicaid |
$145.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$58.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.40
|
| Rate for Payer: Molina Healthcare Passport |
$145.49
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$75.59
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$58.15
|
|
|
INJECTION ANES AGENT/STEROID(T
|
Facility
|
OP
|
$1,176.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761T2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.95 |
| Max. Negotiated Rate |
$1,129.44 |
| Rate for Payer: Aetna Commercial |
$905.90
|
| Rate for Payer: Anthem Medicaid |
$404.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$917.67
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cigna Commercial |
$976.50
|
| Rate for Payer: First Health Commercial |
$1,117.67
|
| Rate for Payer: Humana Commercial |
$1,000.02
|
| Rate for Payer: Humana KY Medicaid |
$404.60
|
| Rate for Payer: Kentucky WC Medicaid |
$408.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$964.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$868.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,035.32
|
| Rate for Payer: Ohio Health Group HMO |
$882.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$811.78
|
| Rate for Payer: PHCS Commercial |
$1,129.44
|
| Rate for Payer: United Healthcare All Payer |
$1,035.32
|
|
|
INJECTION ANES AGENT/STEROID(T
|
Facility
|
IP
|
$1,176.50
|
|
|
Service Code
|
HCPCS 64480
|
| Hospital Charge Code |
761T2322
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.95 |
| Max. Negotiated Rate |
$1,129.44 |
| Rate for Payer: Aetna Commercial |
$905.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$917.67
|
| Rate for Payer: Cash Price |
$588.25
|
| Rate for Payer: Cigna Commercial |
$976.50
|
| Rate for Payer: First Health Commercial |
$1,117.67
|
| Rate for Payer: Humana Commercial |
$1,000.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$964.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$868.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,035.32
|
| Rate for Payer: Ohio Health Group HMO |
$882.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,023.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$811.78
|
| Rate for Payer: PHCS Commercial |
$1,129.44
|
| Rate for Payer: United Healthcare All Payer |
$1,035.32
|
|
|
INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)
|
Facility
|
OP
|
$1,151.65
|
|
|
Service Code
|
CPT 64520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$1,151.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
|
|
INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
|
Facility
|
OP
|
$381.85
|
|
|
Service Code
|
CPT 64505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
761P2313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$217.27 |
| Rate for Payer: Aetna Commercial |
$116.61
|
| Rate for Payer: Ambetter Exchange |
$52.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.75
|
| Rate for Payer: Anthem Medicaid |
$66.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.12
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$217.27
|
| Rate for Payer: Healthspan PPO |
$159.64
|
| Rate for Payer: Humana Medicaid |
$66.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.52
|
| Rate for Payer: Molina Healthcare Passport |
$66.20
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.38
|
| Rate for Payer: UHCCP Medicaid |
$39.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.60
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
IP
|
$1,500.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
76102313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.07 |
| Max. Negotiated Rate |
$1,440.24 |
| Rate for Payer: Aetna Commercial |
$1,155.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.19
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cigna Commercial |
$1,245.21
|
| Rate for Payer: First Health Commercial |
$1,425.24
|
| Rate for Payer: Humana Commercial |
$1,275.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.17
|
| Rate for Payer: PHCS Commercial |
$1,440.24
|
| Rate for Payer: United Healthcare All Payer |
$1,320.22
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
OP
|
$1,500.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
76102313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.94 |
| Max. Negotiated Rate |
$1,440.24 |
| Rate for Payer: Aetna Commercial |
$1,155.19
|
| Rate for Payer: Anthem Medicaid |
$515.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cigna Commercial |
$1,245.21
|
| Rate for Payer: First Health Commercial |
$1,425.24
|
| Rate for Payer: Humana Commercial |
$1,275.21
|
| Rate for Payer: Humana KY Medicaid |
$515.94
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$521.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.17
|
| Rate for Payer: PHCS Commercial |
$1,440.24
|
| Rate for Payer: United Healthcare All Payer |
$1,320.22
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
IP
|
$1,280.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
761T2313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.07 |
| Max. Negotiated Rate |
$1,229.04 |
| Rate for Payer: Aetna Commercial |
$985.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.60
|
| Rate for Payer: Cash Price |
$640.12
|
| Rate for Payer: Cigna Commercial |
$1,062.61
|
| Rate for Payer: First Health Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial |
$1,088.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.62
|
| Rate for Payer: Ohio Health Group HMO |
$960.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.37
|
| Rate for Payer: PHCS Commercial |
$1,229.04
|
| Rate for Payer: United Healthcare All Payer |
$1,126.62
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Facility
|
OP
|
$1,280.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
761T2313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.28 |
| Max. Negotiated Rate |
$1,229.04 |
| Rate for Payer: Aetna Commercial |
$985.79
|
| Rate for Payer: Anthem Medicaid |
$440.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$640.12
|
| Rate for Payer: Cash Price |
$640.12
|
| Rate for Payer: Cigna Commercial |
$1,062.61
|
| Rate for Payer: First Health Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial |
$1,088.21
|
| Rate for Payer: Humana KY Medicaid |
$440.28
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.62
|
| Rate for Payer: Ohio Health Group HMO |
$960.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.37
|
| Rate for Payer: PHCS Commercial |
$1,229.04
|
| Rate for Payer: United Healthcare All Payer |
$1,126.62
|
|
|
INJECTION ANESTHETIC SUBSCAPUL
|
Professional
|
Both
|
$1,500.25
|
|
|
Service Code
|
HCPCS 64418
|
| Hospital Charge Code |
76102313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$900.15 |
| Rate for Payer: Aetna Commercial |
$116.61
|
| Rate for Payer: Ambetter Exchange |
$52.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$37.75
|
| Rate for Payer: Anthem Medicaid |
$66.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$52.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.12
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cash Price |
$750.12
|
| Rate for Payer: Cigna Commercial |
$217.27
|
| Rate for Payer: Healthspan PPO |
$159.64
|
| Rate for Payer: Humana Medicaid |
$66.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$52.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.52
|
| Rate for Payer: Molina Healthcare Passport |
$66.20
|
| Rate for Payer: Multiplan PHCS |
$900.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.38
|
| Rate for Payer: UHCCP Medicaid |
$39.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$52.60
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna Commercial |
$79.85
|
| Rate for Payer: Ambetter Exchange |
$48.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.39
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.49
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$200.32
|
| Rate for Payer: Humana Medicaid |
$43.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.20
|
| Rate for Payer: Molina Healthcare Passport |
$43.33
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.36
|
| Rate for Payer: UHCCP Medicaid |
$40.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.74
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem Medicaid |
$53.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.90
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Humana KY Medicaid |
$53.30
|
| Rate for Payer: Kentucky WC Medicaid |
$53.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
INJECTION ANKLE ARTHROGRAPHY
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
76100905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$148.80 |
| Rate for Payer: Aetna Commercial |
$119.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$120.90
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$128.65
|
| Rate for Payer: First Health Commercial |
$147.25
|
| Rate for Payer: Humana Commercial |
$131.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.40
|
| Rate for Payer: Ohio Health Group HMO |
$116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.95
|
| Rate for Payer: PHCS Commercial |
$148.80
|
| Rate for Payer: United Healthcare All Payer |
$136.40
|
|
|
INJECTION ANKLE ARTHROGRAPHY(P
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 27648
|
| Hospital Charge Code |
761P0905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.39 |
| Max. Negotiated Rate |
$200.32 |
| Rate for Payer: Aetna Commercial |
$79.85
|
| Rate for Payer: Ambetter Exchange |
$48.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.39
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.49
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$200.32
|
| Rate for Payer: Humana Medicaid |
$43.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.20
|
| Rate for Payer: Molina Healthcare Passport |
$43.33
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.36
|
| Rate for Payer: UHCCP Medicaid |
$40.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.74
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$1,213.20 |
| Rate for Payer: Aetna Commercial |
$108.09
|
| Rate for Payer: Ambetter Exchange |
$62.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.81
|
| Rate for Payer: Anthem Medicaid |
$53.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.81
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$292.70
|
| Rate for Payer: Healthspan PPO |
$217.65
|
| Rate for Payer: Humana Medicaid |
$53.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.40
|
| Rate for Payer: Molina Healthcare Passport |
$53.33
|
| Rate for Payer: Multiplan PHCS |
$1,213.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.04
|
| Rate for Payer: UHCCP Medicaid |
$46.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.34
|
|
|
INJECTION ELBOW ARTHROGRAPHY
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
INJECTION ELBOW ARTHROGRAPHY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761P0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Aetna Commercial |
$108.09
|
| Rate for Payer: Ambetter Exchange |
$62.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.81
|
| Rate for Payer: Anthem Medicaid |
$53.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$62.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$62.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.81
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$292.70
|
| Rate for Payer: Healthspan PPO |
$217.65
|
| Rate for Payer: Humana Medicaid |
$53.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$62.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.40
|
| Rate for Payer: Molina Healthcare Passport |
$53.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.04
|
| Rate for Payer: UHCCP Medicaid |
$46.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$62.34
|
|
