|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
|
Facility
|
OP
|
$381.85
|
|
|
Service Code
|
CPT 20553
|
|
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(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")
|
Facility
|
OP
|
$381.85
|
|
|
Service Code
|
CPT 20550
|
|
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 TREATMENT OF NERVE
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
76102819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.00 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
INJECTION TREATMENT OF NERVE
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 64620
|
| Hospital Charge Code |
76102979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$323.66 |
| Rate for Payer: Aetna Commercial |
$264.25
|
| Rate for Payer: Ambetter Exchange |
$168.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.98
|
| Rate for Payer: Anthem Medicaid |
$113.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$201.89
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$243.82
|
| Rate for Payer: Healthspan PPO |
$323.66
|
| Rate for Payer: Humana Medicaid |
$113.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.58
|
| Rate for Payer: Molina Healthcare Passport |
$113.31
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.71
|
| Rate for Payer: UHCCP Medicaid |
$94.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.24
|
|
|
INJECTION TREATMENT OF NERVE
|
Professional
|
Both
|
$3,340.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
76102819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.03 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$345.69
|
| Rate for Payer: Ambetter Exchange |
$208.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.03
|
| Rate for Payer: Anthem Medicaid |
$332.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.06
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$333.63
|
| Rate for Payer: Healthspan PPO |
$471.66
|
| Rate for Payer: Humana Medicaid |
$332.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$254.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$208.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.28
|
| Rate for Payer: Molina Healthcare Passport |
$332.63
|
| Rate for Payer: Multiplan PHCS |
$2,004.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$270.89
|
| Rate for Payer: UHCCP Medicaid |
$119.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
|
|
INJECTION TREATMENT OF NERVE
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
76102819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem Medicaid |
$1,148.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Humana KY Medicaid |
$1,148.63
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
INJECTION TREATMENT OF NERVE(P
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
761P2819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.03 |
| Max. Negotiated Rate |
$471.66 |
| Rate for Payer: Aetna Commercial |
$345.69
|
| Rate for Payer: Ambetter Exchange |
$208.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.03
|
| Rate for Payer: Anthem Medicaid |
$332.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.06
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$333.63
|
| Rate for Payer: Healthspan PPO |
$471.66
|
| Rate for Payer: Humana Medicaid |
$332.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$254.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$208.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.28
|
| Rate for Payer: Molina Healthcare Passport |
$332.63
|
| Rate for Payer: Multiplan PHCS |
$291.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$270.89
|
| Rate for Payer: UHCCP Medicaid |
$119.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.38
|
|
|
INJECTION TREATMENT OF NERVE(T
|
Facility
|
OP
|
$2,855.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
761T2819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$822.61 |
| Max. Negotiated Rate |
$2,740.80 |
| Rate for Payer: Aetna Commercial |
$2,198.35
|
| Rate for Payer: Anthem Medicaid |
$981.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,226.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,151.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.52
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cigna Commercial |
$2,369.65
|
| Rate for Payer: First Health Commercial |
$2,712.25
|
| Rate for Payer: Humana Commercial |
$2,426.75
|
| Rate for Payer: Humana KY Medicaid |
$981.83
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$991.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,001.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,512.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,483.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.95
|
| Rate for Payer: PHCS Commercial |
$2,740.80
|
| Rate for Payer: United Healthcare All Payer |
$2,512.40
|
|
|
INJECTION TREATMENT OF NERVE(T
|
Facility
|
IP
|
$2,855.00
|
|
|
Service Code
|
HCPCS 64681
|
| Hospital Charge Code |
761T2819
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$856.50 |
| Max. Negotiated Rate |
$2,740.80 |
| Rate for Payer: Aetna Commercial |
$2,198.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,226.90
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cigna Commercial |
$2,369.65
|
| Rate for Payer: First Health Commercial |
$2,712.25
|
| Rate for Payer: Humana Commercial |
$2,426.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$856.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,512.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,483.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.95
|
| Rate for Payer: PHCS Commercial |
$2,740.80
|
| Rate for Payer: United Healthcare All Payer |
$2,512.40
|
|
|
INJECTOR NEEDLE KIT 4MM*27G
|
Facility
|
OP
|
$1,149.55
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.87 |
| Max. Negotiated Rate |
$1,103.57 |
| Rate for Payer: Aetna Commercial |
$885.15
|
| Rate for Payer: Anthem Medicaid |
$395.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.65
|
| Rate for Payer: Cash Price |
$574.78
|
| Rate for Payer: Cigna Commercial |
$954.13
|
| Rate for Payer: First Health Commercial |
$1,092.07
|
| Rate for Payer: Humana Commercial |
$977.12
|
| Rate for Payer: Humana KY Medicaid |
$395.33
|
| Rate for Payer: Kentucky WC Medicaid |
$399.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.60
|
| Rate for Payer: Ohio Health Group HMO |
$862.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.19
|
| Rate for Payer: PHCS Commercial |
$1,103.57
|
| Rate for Payer: United Healthcare All Payer |
$1,011.60
|
|
|
INJECTOR NEEDLE KIT 4MM*27G
|
Facility
|
IP
|
$1,149.55
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$344.87 |
| Max. Negotiated Rate |
$1,103.57 |
| Rate for Payer: Aetna Commercial |
$885.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.65
|
| Rate for Payer: Cash Price |
$574.78
|
| Rate for Payer: Cigna Commercial |
$954.13
|
| Rate for Payer: First Health Commercial |
$1,092.07
|
| Rate for Payer: Humana Commercial |
$977.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.60
|
| Rate for Payer: Ohio Health Group HMO |
$862.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.19
|
| Rate for Payer: PHCS Commercial |
$1,103.57
|
| Rate for Payer: United Healthcare All Payer |
$1,011.60
|
|
|
INJECT.PROCEDURE - ABD.SHUNT
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
76102003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
INJECT.PROCEDURE - ABD.SHUNT
|
Professional
|
Both
|
$1,197.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
76102003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$718.20 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Ambetter Exchange |
$37.51
|
| Rate for Payer: Anthem Medicaid |
$39.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.01
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Healthspan PPO |
$62.88
|
| Rate for Payer: Humana Medicaid |
$39.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.99
|
| Rate for Payer: Multiplan PHCS |
$718.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.76
|
| Rate for Payer: UHCCP Medicaid |
$418.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.51
|
|
|
INJECT.PROCEDURE - ABD.SHUNT
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
76102003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$957.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.93
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
INJECT.PROCEDURE - ABD.SHUNT(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
761P2003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.51 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Ambetter Exchange |
$37.51
|
| Rate for Payer: Anthem Medicaid |
$39.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.01
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$67.20
|
| Rate for Payer: Healthspan PPO |
$62.88
|
| Rate for Payer: Humana Medicaid |
$39.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.79
|
| Rate for Payer: Molina Healthcare Passport |
$39.99
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.76
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.51
|
|
|
INJECT.PROCEDURE - ABD.SHUNT(T
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
761T2003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.10 |
| Max. Negotiated Rate |
$765.12 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.93
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
INJECT.PROCEDURE - ABD.SHUNT(T
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
HCPCS 49427
|
| Hospital Charge Code |
761T2003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.10 |
| Max. Negotiated Rate |
$765.12 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem Medicaid |
$274.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Humana KY Medicaid |
$274.09
|
| Rate for Payer: Kentucky WC Medicaid |
$276.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.93
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
INJECT PULM ART HRT CATH
|
Professional
|
Both
|
$2,516.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
76102491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$1,509.60 |
| Rate for Payer: Aetna Commercial |
$70.98
|
| Rate for Payer: Ambetter Exchange |
$43.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.23
|
| Rate for Payer: Anthem Medicaid |
$133.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.33
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cigna Commercial |
$78.50
|
| Rate for Payer: Healthspan PPO |
$177.26
|
| Rate for Payer: Humana Medicaid |
$133.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.19
|
| Rate for Payer: Molina Healthcare Passport |
$133.52
|
| Rate for Payer: Multiplan PHCS |
$1,509.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.69
|
| Rate for Payer: UHCCP Medicaid |
$25.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.61
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$2,083.20 |
| Rate for Payer: Aetna Commercial |
$1,670.90
|
| Rate for Payer: Anthem Medicaid |
$746.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,692.60
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cigna Commercial |
$1,801.10
|
| Rate for Payer: First Health Commercial |
$2,061.50
|
| Rate for Payer: Humana Commercial |
$1,844.50
|
| Rate for Payer: Humana KY Medicaid |
$746.26
|
| Rate for Payer: Kentucky WC Medicaid |
$753.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,779.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,601.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,909.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,627.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,887.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,497.30
|
| Rate for Payer: PHCS Commercial |
$2,083.20
|
| Rate for Payer: United Healthcare All Payer |
$1,909.60
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
OP
|
$2,516.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
76102491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.80 |
| Max. Negotiated Rate |
$2,415.36 |
| Rate for Payer: Aetna Commercial |
$1,937.32
|
| Rate for Payer: Anthem Medicaid |
$865.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,962.48
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cigna Commercial |
$2,088.28
|
| Rate for Payer: First Health Commercial |
$2,390.20
|
| Rate for Payer: Humana Commercial |
$2,138.60
|
| Rate for Payer: Humana KY Medicaid |
$865.25
|
| Rate for Payer: Kentucky WC Medicaid |
$874.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$882.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.04
|
| Rate for Payer: PHCS Commercial |
$2,415.36
|
| Rate for Payer: United Healthcare All Payer |
$2,214.08
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
IP
|
$2,170.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$2,083.20 |
| Rate for Payer: Aetna Commercial |
$1,670.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,692.60
|
| Rate for Payer: Cash Price |
$1,085.00
|
| Rate for Payer: Cigna Commercial |
$1,801.10
|
| Rate for Payer: First Health Commercial |
$2,061.50
|
| Rate for Payer: Humana Commercial |
$1,844.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,779.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,601.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,909.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,627.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,887.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,497.30
|
| Rate for Payer: PHCS Commercial |
$2,083.20
|
| Rate for Payer: United Healthcare All Payer |
$1,909.60
|
|
|
INJECT PULM ART HRT CATH
|
Facility
|
IP
|
$2,516.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
76102491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.80 |
| Max. Negotiated Rate |
$2,415.36 |
| Rate for Payer: Aetna Commercial |
$1,937.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,962.48
|
| Rate for Payer: Cash Price |
$1,258.00
|
| Rate for Payer: Cigna Commercial |
$2,088.28
|
| Rate for Payer: First Health Commercial |
$2,390.20
|
| Rate for Payer: Humana Commercial |
$2,138.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,063.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,856.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,214.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,887.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,012.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,188.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,736.04
|
| Rate for Payer: PHCS Commercial |
$2,415.36
|
| Rate for Payer: United Healthcare All Payer |
$2,214.08
|
|
|
INJECT PULM ART HRT CATH(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761P2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$70.98
|
| Rate for Payer: Ambetter Exchange |
$43.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.23
|
| Rate for Payer: Anthem Medicaid |
$133.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.33
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$78.50
|
| Rate for Payer: Healthspan PPO |
$177.26
|
| Rate for Payer: Humana Medicaid |
$133.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.19
|
| Rate for Payer: Molina Healthcare Passport |
$133.52
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.69
|
| Rate for Payer: UHCCP Medicaid |
$25.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.61
|
|
|
INJECT PULM ART HRT CATH(T
|
Facility
|
IP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761T2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.80 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,884.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.54
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
|
INJECT PULM ART HRT CATH(T
|
Facility
|
OP
|
$2,166.00
|
|
|
Service Code
|
HCPCS 93568
|
| Hospital Charge Code |
761T2491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$649.80 |
| Max. Negotiated Rate |
$2,079.36 |
| Rate for Payer: Aetna Commercial |
$1,667.82
|
| Rate for Payer: Anthem Medicaid |
$744.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,689.48
|
| Rate for Payer: Cash Price |
$1,083.00
|
| Rate for Payer: Cigna Commercial |
$1,797.78
|
| Rate for Payer: First Health Commercial |
$2,057.70
|
| Rate for Payer: Humana Commercial |
$1,841.10
|
| Rate for Payer: Humana KY Medicaid |
$744.89
|
| Rate for Payer: Kentucky WC Medicaid |
$752.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,776.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,598.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,906.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,624.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,884.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.54
|
| Rate for Payer: PHCS Commercial |
$2,079.36
|
| Rate for Payer: United Healthcare All Payer |
$1,906.08
|
|
