|
INJECTION FOR MYELOGRAM
|
Facility
|
OP
|
$1,949.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.70 |
| Max. Negotiated Rate |
$1,871.04 |
| Rate for Payer: Aetna Commercial |
$1,500.73
|
| Rate for Payer: Anthem Medicaid |
$670.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.22
|
| Rate for Payer: Cash Price |
$974.50
|
| Rate for Payer: Cigna Commercial |
$1,617.67
|
| Rate for Payer: First Health Commercial |
$1,851.55
|
| Rate for Payer: Humana Commercial |
$1,656.65
|
| Rate for Payer: Humana KY Medicaid |
$670.26
|
| Rate for Payer: Kentucky WC Medicaid |
$677.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$683.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,695.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.81
|
| Rate for Payer: PHCS Commercial |
$1,871.04
|
| Rate for Payer: United Healthcare All Payer |
$1,715.12
|
|
|
INJECTION FOR MYELOGRAM
|
Professional
|
Both
|
$1,949.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$1,169.40 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Ambetter Exchange |
$77.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$106.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.42
|
| Rate for Payer: Cash Price |
$974.50
|
| Rate for Payer: Cash Price |
$974.50
|
| Rate for Payer: Cigna Commercial |
$131.88
|
| Rate for Payer: Healthspan PPO |
$266.48
|
| Rate for Payer: Humana Medicaid |
$106.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.69
|
| Rate for Payer: Molina Healthcare Passport |
$106.56
|
| Rate for Payer: Multiplan PHCS |
$1,169.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.20
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.85
|
|
|
INJECTION FOR MYELOGRAM
|
Facility
|
IP
|
$1,949.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
76102293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.70 |
| Max. Negotiated Rate |
$1,871.04 |
| Rate for Payer: Aetna Commercial |
$1,500.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,520.22
|
| Rate for Payer: Cash Price |
$974.50
|
| Rate for Payer: Cigna Commercial |
$1,617.67
|
| Rate for Payer: First Health Commercial |
$1,851.55
|
| Rate for Payer: Humana Commercial |
$1,656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,598.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,438.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,715.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,461.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,559.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,695.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.81
|
| Rate for Payer: PHCS Commercial |
$1,871.04
|
| Rate for Payer: United Healthcare All Payer |
$1,715.12
|
|
|
INJECTION FOR MYELOGRAM(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761P2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Ambetter Exchange |
$77.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$106.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$93.42
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$131.88
|
| Rate for Payer: Healthspan PPO |
$266.48
|
| Rate for Payer: Humana Medicaid |
$106.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.69
|
| Rate for Payer: Molina Healthcare Passport |
$106.56
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.20
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.85
|
|
|
INJECTION FOR MYELOGRAM(T
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761T2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
INJECTION FOR MYELOGRAM(T
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 62284
|
| Hospital Charge Code |
761T2293
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem Medicaid |
$472.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Humana KY Medicaid |
$472.52
|
| Rate for Payer: Kentucky WC Medicaid |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Facility
|
OP
|
$1,289.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.70 |
| Max. Negotiated Rate |
$1,237.44 |
| Rate for Payer: Aetna Commercial |
$992.53
|
| Rate for Payer: Anthem Medicaid |
$443.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,005.42
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cigna Commercial |
$1,069.87
|
| Rate for Payer: First Health Commercial |
$1,224.55
|
| Rate for Payer: Humana Commercial |
$1,095.65
|
| Rate for Payer: Humana KY Medicaid |
$443.29
|
| Rate for Payer: Kentucky WC Medicaid |
$447.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,056.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$951.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,134.32
|
| Rate for Payer: Ohio Health Group HMO |
$966.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$889.41
|
| Rate for Payer: PHCS Commercial |
$1,237.44
|
| Rate for Payer: United Healthcare All Payer |
$1,134.32
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.70 |
| Max. Negotiated Rate |
$1,237.44 |
| Rate for Payer: Aetna Commercial |
$992.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,005.42
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cigna Commercial |
$1,069.87
|
| Rate for Payer: First Health Commercial |
$1,224.55
|
| Rate for Payer: Humana Commercial |
$1,095.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,056.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$951.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$386.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,134.32
|
| Rate for Payer: Ohio Health Group HMO |
$966.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$889.41
|
| Rate for Payer: PHCS Commercial |
$1,237.44
|
| Rate for Payer: United Healthcare All Payer |
$1,134.32
|
|
|
INJECTION FOR SHOULDER X-RAY
|
Professional
|
Both
|
$1,289.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
32001014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$773.40 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cash Price |
$644.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$773.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
INJECTION FOR SHOULDER X-RAY(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320P1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
INJECTION FOR SHOULDER X-RAY(T
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320T1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem Medicaid |
$228.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Humana KY Medicaid |
$228.35
|
| Rate for Payer: Kentucky WC Medicaid |
$230.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.16
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
INJECTION FOR SHOULDER X-RAY(T
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
320T1014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.16
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
INJECTION FOR URETER X-RAY
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
INJECTION FOR URETER X-RAY
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 50690
|
| Hospital Charge Code |
76102888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.95 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$113.16
|
| Rate for Payer: Ambetter Exchange |
$66.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.95
|
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$66.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.24
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$104.54
|
| Rate for Payer: Healthspan PPO |
$125.15
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$66.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.84
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$66.03
|
|
|
INJECTION FOR WRIST X-RAY
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
76100594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,470.72 |
| Rate for Payer: Aetna Commercial |
$1,179.64
|
| Rate for Payer: Anthem Medicaid |
$526.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.96
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cigna Commercial |
$1,271.56
|
| Rate for Payer: First Health Commercial |
$1,455.40
|
| Rate for Payer: Humana Commercial |
$1,302.20
|
| Rate for Payer: Humana KY Medicaid |
$526.85
|
| Rate for Payer: Kentucky WC Medicaid |
$532.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.08
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
INJECTION FOR WRIST X-RAY
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
76100594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,470.72 |
| Rate for Payer: Aetna Commercial |
$1,179.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.96
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cigna Commercial |
$1,271.56
|
| Rate for Payer: First Health Commercial |
$1,455.40
|
| Rate for Payer: Humana Commercial |
$1,302.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.08
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
INJECTION FOR WRIST X-RAY
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
76100594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$919.20 |
| Rate for Payer: Aetna Commercial |
$119.02
|
| Rate for Payer: Ambetter Exchange |
$68.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.09
|
| Rate for Payer: Anthem Medicaid |
$57.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.10
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: Healthspan PPO |
$221.73
|
| Rate for Payer: Humana Medicaid |
$57.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.31
|
| Rate for Payer: Molina Healthcare Passport |
$57.17
|
| Rate for Payer: Multiplan PHCS |
$919.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.95
|
| Rate for Payer: UHCCP Medicaid |
$49.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.42
|
|
|
INJECTION FOR WRIST X-RAY(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
761P0594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.09 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$119.02
|
| Rate for Payer: Ambetter Exchange |
$68.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.09
|
| Rate for Payer: Anthem Medicaid |
$57.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$82.10
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$293.25
|
| Rate for Payer: Healthspan PPO |
$221.73
|
| Rate for Payer: Humana Medicaid |
$57.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.31
|
| Rate for Payer: Molina Healthcare Passport |
$57.17
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.95
|
| Rate for Payer: UHCCP Medicaid |
$49.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.42
|
|
|
INJECTION FOR WRIST X-RAY(T
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
761T0594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
INJECTION FOR WRIST X-RAY(T
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 25246
|
| Hospital Charge Code |
761T0594
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$320.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$320.51
|
| Rate for Payer: Kentucky WC Medicaid |
$323.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
INJECTION HIP ARTHROGRAPHY
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
76100776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$1,348.80 |
| Rate for Payer: Aetna Commercial |
$111.06
|
| Rate for Payer: Ambetter Exchange |
$64.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.22
|
| Rate for Payer: Anthem Medicaid |
$62.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.03
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$115.72
|
| Rate for Payer: Healthspan PPO |
$244.59
|
| Rate for Payer: Humana Medicaid |
$62.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.07
|
| Rate for Payer: Molina Healthcare Passport |
$62.81
|
| Rate for Payer: Multiplan PHCS |
$1,348.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.45
|
| Rate for Payer: UHCCP Medicaid |
$53.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.19
|
|
|
INJECTION HIP ARTHROGRAPHY
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
76100776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem Medicaid |
$773.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Humana KY Medicaid |
$773.09
|
| Rate for Payer: Kentucky WC Medicaid |
$780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
INJECTION HIP ARTHROGRAPHY
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
76100776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
INJECTION HIP ARTHROGRAPHY(P
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 27093
|
| Hospital Charge Code |
761P0776
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Commercial |
$111.06
|
| Rate for Payer: Ambetter Exchange |
$64.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.22
|
| Rate for Payer: Anthem Medicaid |
$62.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.03
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$115.72
|
| Rate for Payer: Healthspan PPO |
$244.59
|
| Rate for Payer: Humana Medicaid |
$62.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.07
|
| Rate for Payer: Molina Healthcare Passport |
$62.81
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.45
|
| Rate for Payer: UHCCP Medicaid |
$53.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.19
|
|
