|
INJ FOR HIP XRAY WANESTH(T
|
Facility
|
OP
|
$1,575.38
|
|
|
Service Code
|
HCPCS 27095
|
| Hospital Charge Code |
761T0777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.61 |
| Max. Negotiated Rate |
$1,512.36 |
| Rate for Payer: Aetna Commercial |
$1,213.04
|
| Rate for Payer: Anthem Medicaid |
$541.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.80
|
| Rate for Payer: Cash Price |
$787.69
|
| Rate for Payer: Cigna Commercial |
$1,307.57
|
| Rate for Payer: First Health Commercial |
$1,496.61
|
| Rate for Payer: Humana Commercial |
$1,339.07
|
| Rate for Payer: Humana KY Medicaid |
$541.77
|
| Rate for Payer: Kentucky WC Medicaid |
$547.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.01
|
| Rate for Payer: PHCS Commercial |
$1,512.36
|
| Rate for Payer: United Healthcare All Payer |
$1,386.33
|
|
|
INJ FOR HIP XRAY WANESTH(T
|
Facility
|
IP
|
$1,575.38
|
|
|
Service Code
|
HCPCS 27095
|
| Hospital Charge Code |
761T0777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.61 |
| Max. Negotiated Rate |
$1,512.36 |
| Rate for Payer: Aetna Commercial |
$1,213.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.80
|
| Rate for Payer: Cash Price |
$787.69
|
| Rate for Payer: Cigna Commercial |
$1,307.57
|
| Rate for Payer: First Health Commercial |
$1,496.61
|
| Rate for Payer: Humana Commercial |
$1,339.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,370.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,087.01
|
| Rate for Payer: PHCS Commercial |
$1,512.36
|
| Rate for Payer: United Healthcare All Payer |
$1,386.33
|
|
|
INJ MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$1,262.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
76100277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna Commercial |
$971.74
|
| Rate for Payer: Anthem Medicaid |
$434.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$984.36
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,047.46
|
| Rate for Payer: First Health Commercial |
$1,198.90
|
| Rate for Payer: Humana Commercial |
$1,072.70
|
| Rate for Payer: Humana KY Medicaid |
$434.00
|
| Rate for Payer: Kentucky WC Medicaid |
$438.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$931.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,110.56
|
| Rate for Payer: Ohio Health Group HMO |
$946.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.78
|
| Rate for Payer: PHCS Commercial |
$1,211.52
|
| Rate for Payer: United Healthcare All Payer |
$1,110.56
|
|
|
INJ MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$1,262.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
76100277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna Commercial |
$971.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$984.36
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,047.46
|
| Rate for Payer: First Health Commercial |
$1,198.90
|
| Rate for Payer: Humana Commercial |
$1,072.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$931.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,110.56
|
| Rate for Payer: Ohio Health Group HMO |
$946.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.78
|
| Rate for Payer: PHCS Commercial |
$1,211.52
|
| Rate for Payer: United Healthcare All Payer |
$1,110.56
|
|
|
INJ MAMMARY DUCTOGRAM
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
76100277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$757.20 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Ambetter Exchange |
$71.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.07
|
| Rate for Payer: Anthem Medicaid |
$59.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$113.06
|
| Rate for Payer: Healthspan PPO |
$193.01
|
| Rate for Payer: Humana Medicaid |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Molina Healthcare Passport |
$59.01
|
| Rate for Payer: Multiplan PHCS |
$757.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.30
|
| Rate for Payer: UHCCP Medicaid |
$39.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.00
|
|
|
INJ MAMMARY DUCTOGRAM(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
761P0277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.07 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Ambetter Exchange |
$71.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.07
|
| Rate for Payer: Anthem Medicaid |
$59.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$113.06
|
| Rate for Payer: Healthspan PPO |
$193.01
|
| Rate for Payer: Humana Medicaid |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Molina Healthcare Passport |
$59.01
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.30
|
| Rate for Payer: UHCCP Medicaid |
$39.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.00
|
|
|
INJ MAMMARY DUCTOGRAM(T
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
761T0277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem Medicaid |
$210.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Humana KY Medicaid |
$210.47
|
| Rate for Payer: Kentucky WC Medicaid |
$212.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.28
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
INJ MAMMARY DUCTOGRAM(T
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
HCPCS 19030
|
| Hospital Charge Code |
761T0277
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$587.52 |
| Rate for Payer: Aetna Commercial |
$471.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$477.36
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$507.96
|
| Rate for Payer: First Health Commercial |
$581.40
|
| Rate for Payer: Humana Commercial |
$520.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$451.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$538.56
|
| Rate for Payer: Ohio Health Group HMO |
$459.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$489.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.28
|
| Rate for Payer: PHCS Commercial |
$587.52
|
| Rate for Payer: United Healthcare All Payer |
$538.56
|
|
|
INJ METHYLENE BLUE LUNG LESION
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 96379
|
| Hospital Charge Code |
26000014
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$123.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.20
|
| Rate for Payer: UHCCP Medicaid |
$72.10
|
|
|
INJ METHYLENE BLUE LUNG LESION
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 96379
|
| Hospital Charge Code |
26000014
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
INJ METHYLENE BLUE LUNG LESION
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 96379
|
| Hospital Charge Code |
26000014
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
INJ PARAVERT F JNT 1 LEVER
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
76102329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.30 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INJ PARAVERT F JNT 1 LEVER
|
Professional
|
Both
|
$2,231.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
76102329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$154.68
|
| Rate for Payer: Ambetter Exchange |
$85.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.51
|
| Rate for Payer: Anthem Medicaid |
$119.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.54
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$265.87
|
| Rate for Payer: Healthspan PPO |
$150.79
|
| Rate for Payer: Humana Medicaid |
$119.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.70
|
| Rate for Payer: Molina Healthcare Passport |
$119.31
|
| Rate for Payer: Multiplan PHCS |
$1,338.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.08
|
| Rate for Payer: UHCCP Medicaid |
$47.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.45
|
|
|
INJ PARAVERT F JNT 1 LEVER
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
76102329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$767.24 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| 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 |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,940.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,539.39
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INJ PARAVERT F JNT 1 LEVER(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
761P2329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$265.87 |
| Rate for Payer: Aetna Commercial |
$154.68
|
| Rate for Payer: Ambetter Exchange |
$85.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.51
|
| Rate for Payer: Anthem Medicaid |
$119.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.54
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$265.87
|
| Rate for Payer: Healthspan PPO |
$150.79
|
| Rate for Payer: Humana Medicaid |
$119.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.70
|
| Rate for Payer: Molina Healthcare Passport |
$119.31
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.08
|
| Rate for Payer: UHCCP Medicaid |
$47.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.45
|
|
|
INJ PARAVERT F JNT 1 LEVER(T
|
Facility
|
OP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
761T2329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.27 |
| Max. Negotiated Rate |
$1,901.76 |
| Rate for Payer: Aetna Commercial |
$1,525.37
|
| Rate for Payer: Anthem Medicaid |
$681.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$822.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.18
|
| 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 |
$990.50
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cigna Commercial |
$1,644.23
|
| Rate for Payer: First Health Commercial |
$1,881.95
|
| Rate for Payer: Humana Commercial |
$1,683.85
|
| Rate for Payer: Humana KY Medicaid |
$681.27
|
| Rate for Payer: Humana Medicare Advantage |
$822.61
|
| Rate for Payer: Kentucky WC Medicaid |
$688.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,723.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.89
|
| Rate for Payer: PHCS Commercial |
$1,901.76
|
| Rate for Payer: United Healthcare All Payer |
$1,743.28
|
|
|
INJ PARAVERT F JNT 1 LEVER(T
|
Facility
|
IP
|
$1,981.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
761T2329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.30 |
| Max. Negotiated Rate |
$1,901.76 |
| Rate for Payer: Aetna Commercial |
$1,525.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,545.18
|
| Rate for Payer: Cash Price |
$990.50
|
| Rate for Payer: Cigna Commercial |
$1,644.23
|
| Rate for Payer: First Health Commercial |
$1,881.95
|
| Rate for Payer: Humana Commercial |
$1,683.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,743.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,723.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.89
|
| Rate for Payer: PHCS Commercial |
$1,901.76
|
| Rate for Payer: United Healthcare All Payer |
$1,743.28
|
|
|
INJ PARAVERT F JNT 2 LEVER
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
76102330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$1,189.44 |
| Rate for Payer: Aetna Commercial |
$954.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$966.42
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,028.37
|
| Rate for Payer: First Health Commercial |
$1,177.05
|
| Rate for Payer: Humana Commercial |
$1,053.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$914.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$929.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.91
|
| Rate for Payer: PHCS Commercial |
$1,189.44
|
| Rate for Payer: United Healthcare All Payer |
$1,090.32
|
|
|
INJ PARAVERT F JNT 2 LEVER
|
Professional
|
Both
|
$1,239.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
76102330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Ambetter Exchange |
$48.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.96
|
| Rate for Payer: Anthem Medicaid |
$61.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.67
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$137.08
|
| Rate for Payer: Healthspan PPO |
$74.40
|
| Rate for Payer: Humana Medicaid |
$61.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.97
|
| Rate for Payer: Molina Healthcare Passport |
$61.74
|
| Rate for Payer: Multiplan PHCS |
$743.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.06
|
|
|
INJ PARAVERT F JNT 2 LEVER
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
76102330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.70 |
| Max. Negotiated Rate |
$1,189.44 |
| Rate for Payer: Aetna Commercial |
$954.03
|
| Rate for Payer: Anthem Medicaid |
$426.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$966.42
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,028.37
|
| Rate for Payer: First Health Commercial |
$1,177.05
|
| Rate for Payer: Humana Commercial |
$1,053.15
|
| Rate for Payer: Humana KY Medicaid |
$426.09
|
| Rate for Payer: Kentucky WC Medicaid |
$430.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,015.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$914.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$929.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$991.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,077.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$854.91
|
| Rate for Payer: PHCS Commercial |
$1,189.44
|
| Rate for Payer: United Healthcare All Payer |
$1,090.32
|
|
|
INJ PARAVERT F JNT 2 LEVER(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
761P2330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.96 |
| Max. Negotiated Rate |
$137.08 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Ambetter Exchange |
$48.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.96
|
| Rate for Payer: Anthem Medicaid |
$61.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.67
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$137.08
|
| Rate for Payer: Healthspan PPO |
$74.40
|
| Rate for Payer: Humana Medicaid |
$61.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.97
|
| Rate for Payer: Molina Healthcare Passport |
$61.74
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.06
|
|
|
INJ PARAVERT F JNT 2 LEVER(T
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
761T2330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$1,045.44 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.42
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$903.87
|
| Rate for Payer: First Health Commercial |
$1,034.55
|
| Rate for Payer: Humana Commercial |
$925.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.32
|
| Rate for Payer: Ohio Health Group HMO |
$816.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.41
|
| Rate for Payer: PHCS Commercial |
$1,045.44
|
| Rate for Payer: United Healthcare All Payer |
$958.32
|
|
|
INJ PARAVERT F JNT 2 LEVER(T
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
761T2330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$1,045.44 |
| Rate for Payer: Aetna Commercial |
$838.53
|
| Rate for Payer: Anthem Medicaid |
$374.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.42
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna Commercial |
$903.87
|
| Rate for Payer: First Health Commercial |
$1,034.55
|
| Rate for Payer: Humana Commercial |
$925.65
|
| Rate for Payer: Humana KY Medicaid |
$374.51
|
| Rate for Payer: Kentucky WC Medicaid |
$378.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.32
|
| Rate for Payer: Ohio Health Group HMO |
$816.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$751.41
|
| Rate for Payer: PHCS Commercial |
$1,045.44
|
| Rate for Payer: United Healthcare All Payer |
$958.32
|
|
|
INJ PARAVERT F JNT 3 LEVER
|
Facility
|
OP
|
$1,154.82
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
76102331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$1,108.63 |
| Rate for Payer: Aetna Commercial |
$889.21
|
| Rate for Payer: Anthem Medicaid |
$397.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$900.76
|
| Rate for Payer: Cash Price |
$577.41
|
| Rate for Payer: Cigna Commercial |
$958.50
|
| Rate for Payer: First Health Commercial |
$1,097.08
|
| Rate for Payer: Humana Commercial |
$981.60
|
| Rate for Payer: Humana KY Medicaid |
$397.14
|
| Rate for Payer: Kentucky WC Medicaid |
$401.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$946.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.24
|
| Rate for Payer: Ohio Health Group HMO |
$866.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.83
|
| Rate for Payer: PHCS Commercial |
$1,108.63
|
| Rate for Payer: United Healthcare All Payer |
$1,016.24
|
|
|
INJ PARAVERT F JNT 3 LEVER
|
Facility
|
IP
|
$1,154.82
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
76102331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$1,108.63 |
| Rate for Payer: Aetna Commercial |
$889.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$900.76
|
| Rate for Payer: Cash Price |
$577.41
|
| Rate for Payer: Cigna Commercial |
$958.50
|
| Rate for Payer: First Health Commercial |
$1,097.08
|
| Rate for Payer: Humana Commercial |
$981.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$946.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.24
|
| Rate for Payer: Ohio Health Group HMO |
$866.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$796.83
|
| Rate for Payer: PHCS Commercial |
$1,108.63
|
| Rate for Payer: United Healthcare All Payer |
$1,016.24
|
|
