|
INJECT R VENTR/ATRIAL ANGIO
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
48000097
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
INJECT R VENTR/ATRIAL ANGIO
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 93566
|
| Hospital Charge Code |
48000097
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
INJECT SACROILIAC JOINT
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$1,143.60 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Ambetter Exchange |
$78.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$292.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.22
|
| Rate for Payer: Cash Price |
$953.00
|
| Rate for Payer: Cash Price |
$953.00
|
| Rate for Payer: Cigna Commercial |
$331.08
|
| Rate for Payer: Healthspan PPO |
$223.81
|
| Rate for Payer: Humana Medicaid |
$292.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.93
|
| Rate for Payer: Molina Healthcare Passport |
$292.09
|
| Rate for Payer: Multiplan PHCS |
$1,143.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$65.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.52
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.80 |
| Max. Negotiated Rate |
$1,829.76 |
| Rate for Payer: Aetna Commercial |
$1,467.62
|
| Rate for Payer: Anthem Medicaid |
$655.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,486.68
|
| Rate for Payer: Cash Price |
$953.00
|
| Rate for Payer: Cigna Commercial |
$1,581.98
|
| Rate for Payer: First Health Commercial |
$1,810.70
|
| Rate for Payer: Humana Commercial |
$1,620.10
|
| Rate for Payer: Humana KY Medicaid |
$655.47
|
| Rate for Payer: Kentucky WC Medicaid |
$662.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,406.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.14
|
| Rate for Payer: PHCS Commercial |
$1,829.76
|
| Rate for Payer: United Healthcare All Payer |
$1,677.28
|
|
|
INJECT SACROILIAC JOINT
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
76100778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.80 |
| Max. Negotiated Rate |
$1,829.76 |
| Rate for Payer: Aetna Commercial |
$1,467.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,486.68
|
| Rate for Payer: Cash Price |
$953.00
|
| Rate for Payer: Cigna Commercial |
$1,581.98
|
| Rate for Payer: First Health Commercial |
$1,810.70
|
| Rate for Payer: Humana Commercial |
$1,620.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,406.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,658.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.14
|
| Rate for Payer: PHCS Commercial |
$1,829.76
|
| Rate for Payer: United Healthcare All Payer |
$1,677.28
|
|
|
INJECT SACROILIAC JOINT(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
761P0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.37 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$105.25
|
| Rate for Payer: Ambetter Exchange |
$78.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$292.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$78.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.22
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$331.08
|
| Rate for Payer: Healthspan PPO |
$223.81
|
| Rate for Payer: Humana Medicaid |
$292.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$78.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.93
|
| Rate for Payer: Molina Healthcare Passport |
$292.09
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$65.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.52
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 27096
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.26 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
INJECT SACROILIAC JOINT(T
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS G0260
|
| Hospital Charge Code |
761T0778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
INJECT SKIN LESIONS >7
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem Medicaid |
$144.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Humana KY Medicaid |
$144.78
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
INJECT SKIN LESIONS >7
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.30 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
INJECT SKIN LESIONS >7
|
Professional
|
Both
|
$421.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Ambetter Exchange |
$42.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.15
|
| Rate for Payer: Anthem Medicaid |
$35.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.83
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$88.61
|
| Rate for Payer: Healthspan PPO |
$78.44
|
| Rate for Payer: Humana Medicaid |
$35.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.90
|
| Rate for Payer: Molina Healthcare Passport |
$35.20
|
| Rate for Payer: Multiplan PHCS |
$252.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.07
|
| Rate for Payer: UHCCP Medicaid |
$34.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.36
|
|
|
INJECT SKIN LESIONS >7(P
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761P0108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$69.73
|
| Rate for Payer: Ambetter Exchange |
$42.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.15
|
| Rate for Payer: Anthem Medicaid |
$35.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.83
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$88.61
|
| Rate for Payer: Healthspan PPO |
$78.44
|
| Rate for Payer: Humana Medicaid |
$35.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.90
|
| Rate for Payer: Molina Healthcare Passport |
$35.20
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.07
|
| Rate for Payer: UHCCP Medicaid |
$34.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.36
|
|
|
INJECT SKIN LESIONS >7(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761T0108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
INJECT SKIN LESIONS >7(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 11901
|
| Hospital Charge Code |
761T0108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.09
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.24
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.52
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
INJECT SKIN LESIONS </W 7
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Ambetter Exchange |
$27.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.76
|
| Rate for Payer: Anthem Medicaid |
$22.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.16
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$69.71
|
| Rate for Payer: Healthspan PPO |
$61.52
|
| Rate for Payer: Humana Medicaid |
$22.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.90
|
| Rate for Payer: Molina Healthcare Passport |
$22.45
|
| Rate for Payer: Multiplan PHCS |
$244.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.92
|
| Rate for Payer: UHCCP Medicaid |
$20.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.63
|
|
|
INJECT SKIN LESIONS </W 7
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.31 |
| Max. Negotiated Rate |
$391.68 |
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Anthem Medicaid |
$140.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$318.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$338.64
|
| Rate for Payer: First Health Commercial |
$387.60
|
| Rate for Payer: Humana Commercial |
$346.80
|
| Rate for Payer: Humana KY Medicaid |
$140.31
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$141.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$334.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$301.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$359.04
|
| Rate for Payer: Ohio Health Group HMO |
$306.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.52
|
| Rate for Payer: PHCS Commercial |
$391.68
|
| Rate for Payer: United Healthcare All Payer |
$359.04
|
|
|
INJECT SKIN LESIONS </W 7(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
761P0107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Ambetter Exchange |
$27.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.76
|
| Rate for Payer: Anthem Medicaid |
$22.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.16
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$69.71
|
| Rate for Payer: Healthspan PPO |
$61.52
|
| Rate for Payer: Humana Medicaid |
$22.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.90
|
| Rate for Payer: Molina Healthcare Passport |
$22.45
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.92
|
| Rate for Payer: UHCCP Medicaid |
$20.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.63
|
|
|
INJECT SKIN LESIONS </W 7(T
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
761T0107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
INJECT SKIN LESIONS </W 7(T
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 11900
|
| Hospital Charge Code |
761T0107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
INJECT TRIGGER POINTS 3/>
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.21 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$267.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Humana KY Medicaid |
$267.21
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$269.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.13
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
INJECT TRIGGER POINTS 3/>
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Ambetter Exchange |
$39.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$46.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$39.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.81
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$95.90
|
| Rate for Payer: Healthspan PPO |
$75.25
|
| Rate for Payer: Humana Medicaid |
$46.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$39.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.31
|
| Rate for Payer: Molina Healthcare Passport |
$46.38
|
| Rate for Payer: Multiplan PHCS |
$466.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.71
|
| Rate for Payer: UHCCP Medicaid |
$35.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$39.01
|
|
|
INJECT TRIGGER POINTS 3/>
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 20553
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$621.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.13
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
