|
INJECTION ELBOW ARTHROGRAPHY(T
|
Facility
|
OP
|
$1,172.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761T0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,125.12 |
| Rate for Payer: Aetna Commercial |
$902.44
|
| Rate for Payer: Anthem Medicaid |
$403.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.16
|
| Rate for Payer: Cash Price |
$586.00
|
| Rate for Payer: Cigna Commercial |
$972.76
|
| Rate for Payer: First Health Commercial |
$1,113.40
|
| Rate for Payer: Humana Commercial |
$996.20
|
| Rate for Payer: Humana KY Medicaid |
$403.05
|
| Rate for Payer: Kentucky WC Medicaid |
$407.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$864.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,031.36
|
| Rate for Payer: Ohio Health Group HMO |
$879.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,019.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$808.68
|
| Rate for Payer: PHCS Commercial |
$1,125.12
|
| Rate for Payer: United Healthcare All Payer |
$1,031.36
|
|
|
INJECTION ELBOW ARTHROGRAPHY(T
|
Facility
|
IP
|
$1,172.00
|
|
|
Service Code
|
HCPCS 24220
|
| Hospital Charge Code |
761T0516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.60 |
| Max. Negotiated Rate |
$1,125.12 |
| Rate for Payer: Aetna Commercial |
$902.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.16
|
| Rate for Payer: Cash Price |
$586.00
|
| Rate for Payer: Cigna Commercial |
$972.76
|
| Rate for Payer: First Health Commercial |
$1,113.40
|
| Rate for Payer: Humana Commercial |
$996.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$864.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,031.36
|
| Rate for Payer: Ohio Health Group HMO |
$879.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,019.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$808.68
|
| Rate for Payer: PHCS Commercial |
$1,125.12
|
| Rate for Payer: United Healthcare All Payer |
$1,031.36
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761T2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.61 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| 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 |
$639.87
|
| 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 |
$767.84
|
| 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 |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761P2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Ambetter Exchange |
$60.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.65
|
| Rate for Payer: Anthem Medicaid |
$69.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.43
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$89.26
|
| Rate for Payer: Humana Medicaid |
$69.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.48
|
| Rate for Payer: Molina Healthcare Passport |
$69.10
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.47
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.36
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$706.56
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
761T2318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.70 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.15 |
| Max. Negotiated Rate |
$983.04 |
| Rate for Payer: Aetna Commercial |
$788.48
|
| Rate for Payer: Anthem Medicaid |
$352.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$798.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$849.92
|
| Rate for Payer: First Health Commercial |
$972.80
|
| Rate for Payer: Humana Commercial |
$870.40
|
| Rate for Payer: Humana KY Medicaid |
$352.15
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$355.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$839.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$755.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$901.12
|
| Rate for Payer: Ohio Health Group HMO |
$768.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$819.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$706.56
|
| Rate for Payer: PHCS Commercial |
$983.04
|
| Rate for Payer: United Healthcare All Payer |
$901.12
|
|
|
INJECTION FEMORAL NERVE SINGLE
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 64447
|
| Hospital Charge Code |
76102318
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Ambetter Exchange |
$60.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.65
|
| Rate for Payer: Anthem Medicaid |
$69.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.43
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cigna Commercial |
$149.87
|
| Rate for Payer: Healthspan PPO |
$89.26
|
| Rate for Payer: Humana Medicaid |
$69.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.48
|
| Rate for Payer: Molina Healthcare Passport |
$69.10
|
| Rate for Payer: Multiplan PHCS |
$614.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$78.47
|
| Rate for Payer: UHCCP Medicaid |
$27.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.36
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.95
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem Medicaid |
$328.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Humana KY Medicaid |
$328.42
|
| Rate for Payer: Kentucky WC Medicaid |
$331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.95
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
INJECTION FOR BLADDER X-RAY
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
76102860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Ambetter Exchange |
$61.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.19
|
| Rate for Payer: Anthem Medicaid |
$54.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.20
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$93.67
|
| Rate for Payer: Healthspan PPO |
$138.47
|
| Rate for Payer: Humana Medicaid |
$54.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.47
|
| Rate for Payer: Molina Healthcare Passport |
$54.38
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.30
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.00
|
|
|
INJECTION FOR BLADDER X-RAY
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$359.40 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$40.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.68
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$359.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.74
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.57
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.70 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem Medicaid |
$206.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Humana KY Medicaid |
$206.00
|
| Rate for Payer: Kentucky WC Medicaid |
$208.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJECTION FOR BLADDER X-RAY
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
32001015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.70 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
INJECTION FOR BLADDER X-RAY (P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761P2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$138.47 |
| Rate for Payer: Aetna Commercial |
$103.06
|
| Rate for Payer: Ambetter Exchange |
$61.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.19
|
| Rate for Payer: Anthem Medicaid |
$54.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.20
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$93.67
|
| Rate for Payer: Healthspan PPO |
$138.47
|
| Rate for Payer: Humana Medicaid |
$54.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$86.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.47
|
| Rate for Payer: Molina Healthcare Passport |
$54.38
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.30
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.00
|
|
|
INJECTION FOR BLADDER X-RAY(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320P1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$234.05 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$40.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.39
|
| Rate for Payer: Anthem Medicaid |
$34.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.68
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$66.03
|
| Rate for Payer: Healthspan PPO |
$234.05
|
| Rate for Payer: Humana Medicaid |
$34.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.74
|
| Rate for Payer: Molina Healthcare Passport |
$34.06
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.74
|
| Rate for Payer: UHCCP Medicaid |
$36.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.57
|
|
|
INJECTION FOR BLADDER X-RAY (T
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761T2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INJECTION FOR BLADDER X-RAY (T
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 51610
|
| Hospital Charge Code |
761T2860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INJECTION FOR BLADDER X-RAY(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320T1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJECTION FOR BLADDER X-RAY(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 51600
|
| Hospital Charge Code |
320T1015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
INJECTION FOR BRONCHOGRAPHY
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
41000065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$251.13 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$179.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$251.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.16
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$179.38
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
INJECTION FOR BRONCHOGRAPHY
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
41000065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
INJECTION FOR BRONCHOGRAPHY
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
41000065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
INJECTION FOR BRONCHOGRAPHY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 31899
|
| Hospital Charge Code |
410P0065
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
INJECTION FOR CHOLANGIOGRAM
|
Professional
|
Both
|
$870.12
|
|
|
Service Code
|
HCPCS 47532
|
| Hospital Charge Code |
76102733
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.65 |
| Max. Negotiated Rate |
$628.47 |
| Rate for Payer: Ambetter Exchange |
$197.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.65
|
| Rate for Payer: Anthem Medicaid |
$616.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.59
|
| Rate for Payer: Cash Price |
$435.06
|
| Rate for Payer: Cash Price |
$435.06
|
| Rate for Payer: Cigna Commercial |
$361.99
|
| Rate for Payer: Humana Medicaid |
$616.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$305.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.47
|
| Rate for Payer: Molina Healthcare Passport |
$616.15
|
| Rate for Payer: Multiplan PHCS |
$522.07
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.31
|
| Rate for Payer: UHCCP Medicaid |
$184.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.16
|
|
