|
INJ PROC; LYMPHANGIOGRAPHY(T
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761T1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
INJ PROC; LYMPHANGIOGRAPHY(T
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
HCPCS 38790
|
| Hospital Charge Code |
761T1611
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem Medicaid |
$615.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Humana KY Medicaid |
$615.58
|
| Rate for Payer: Kentucky WC Medicaid |
$621.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.90 |
| Max. Negotiated Rate |
$1,241.28 |
| Rate for Payer: Aetna Commercial |
$995.61
|
| Rate for Payer: Anthem Medicaid |
$444.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.54
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,073.19
|
| Rate for Payer: First Health Commercial |
$1,228.35
|
| Rate for Payer: Humana Commercial |
$1,099.05
|
| Rate for Payer: Humana KY Medicaid |
$444.66
|
| Rate for Payer: Kentucky WC Medicaid |
$449.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,060.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.84
|
| Rate for Payer: Ohio Health Group HMO |
$969.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.17
|
| Rate for Payer: PHCS Commercial |
$1,241.28
|
| Rate for Payer: United Healthcare All Payer |
$1,137.84
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$1,293.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.90 |
| Max. Negotiated Rate |
$1,241.28 |
| Rate for Payer: Aetna Commercial |
$995.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,008.54
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$1,073.19
|
| Rate for Payer: First Health Commercial |
$1,228.35
|
| Rate for Payer: Humana Commercial |
$1,099.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,060.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,137.84
|
| Rate for Payer: Ohio Health Group HMO |
$969.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$892.17
|
| Rate for Payer: PHCS Commercial |
$1,241.28
|
| Rate for Payer: United Healthcare All Payer |
$1,137.84
|
|
|
INJ PROC SHOULDER ARTHROGRAM
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
76100454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$775.80 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cash Price |
$646.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$775.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
INJ PROC SHOULDER ARTHROGRAM(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761P0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$81.80
|
| Rate for Payer: Ambetter Exchange |
$46.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.27
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.27
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$265.25
|
| Rate for Payer: Healthspan PPO |
$197.23
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.96
|
| Rate for Payer: UHCCP Medicaid |
$26.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.89
|
|
|
INJ PROC SHOULDER ARTHROGRAM(T
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761T0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$641.28 |
| Rate for Payer: Aetna Commercial |
$514.36
|
| Rate for Payer: Anthem Medicaid |
$229.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.04
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cigna Commercial |
$554.44
|
| Rate for Payer: First Health Commercial |
$634.60
|
| Rate for Payer: Humana Commercial |
$567.80
|
| Rate for Payer: Humana KY Medicaid |
$229.73
|
| Rate for Payer: Kentucky WC Medicaid |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.84
|
| Rate for Payer: Ohio Health Group HMO |
$501.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.92
|
| Rate for Payer: PHCS Commercial |
$641.28
|
| Rate for Payer: United Healthcare All Payer |
$587.84
|
|
|
INJ PROC SHOULDER ARTHROGRAM(T
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
HCPCS 23350
|
| Hospital Charge Code |
761T0454
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$641.28 |
| Rate for Payer: Aetna Commercial |
$514.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.04
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cigna Commercial |
$554.44
|
| Rate for Payer: First Health Commercial |
$634.60
|
| Rate for Payer: Humana Commercial |
$567.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.84
|
| Rate for Payer: Ohio Health Group HMO |
$501.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.92
|
| Rate for Payer: PHCS Commercial |
$641.28
|
| Rate for Payer: United Healthcare All Payer |
$587.84
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761T1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$151.92
|
| Rate for Payer: Ambetter Exchange |
$71.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.95
|
| Rate for Payer: Anthem Medicaid |
$55.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.42
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$257.90
|
| Rate for Payer: Healthspan PPO |
$200.64
|
| Rate for Payer: Humana Medicaid |
$55.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.51
|
| Rate for Payer: Molina Healthcare Passport |
$55.40
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.53
|
| Rate for Payer: UHCCP Medicaid |
$60.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.18
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761T1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.25
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
76101462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem Medicaid |
$490.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Humana KY Medicaid |
$490.06
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$495.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.25
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
INJ SCLEROSMULTVEINSSAMELEG SP
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 36471
|
| Hospital Charge Code |
761P1462
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$151.92
|
| Rate for Payer: Ambetter Exchange |
$71.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.95
|
| Rate for Payer: Anthem Medicaid |
$55.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.42
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$257.90
|
| Rate for Payer: Healthspan PPO |
$200.64
|
| Rate for Payer: Humana Medicaid |
$55.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.51
|
| Rate for Payer: Molina Healthcare Passport |
$55.40
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$92.53
|
| Rate for Payer: UHCCP Medicaid |
$60.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.18
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
76102489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
76102489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem Medicaid |
$115.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Humana KY Medicaid |
$115.89
|
| Rate for Payer: Kentucky WC Medicaid |
$117.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem Medicaid |
$115.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Humana KY Medicaid |
$115.89
|
| Rate for Payer: Kentucky WC Medicaid |
$117.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJ S&I ATRIAL ANGIO CONGEN HC
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS 93565
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$101.10 |
| Max. Negotiated Rate |
$323.52 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$262.86
|
| Rate for Payer: Cash Price |
$168.50
|
| Rate for Payer: Cigna Commercial |
$279.71
|
| Rate for Payer: First Health Commercial |
$320.15
|
| Rate for Payer: Humana Commercial |
$286.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$276.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$248.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$296.56
|
| Rate for Payer: Ohio Health Group HMO |
$252.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.53
|
| Rate for Payer: PHCS Commercial |
$323.52
|
| Rate for Payer: United Healthcare All Payer |
$296.56
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
OP
|
$989.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
45000295
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.12 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$761.53
|
| Rate for Payer: Anthem Medicaid |
$340.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$771.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cigna Commercial |
$820.87
|
| Rate for Payer: First Health Commercial |
$939.55
|
| Rate for Payer: Humana Commercial |
$840.65
|
| Rate for Payer: Humana KY Medicaid |
$340.12
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$343.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$346.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$870.32
|
| Rate for Payer: Ohio Health Group HMO |
$741.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$860.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.41
|
| Rate for Payer: PHCS Commercial |
$949.44
|
| Rate for Payer: United Healthcare All Payer |
$870.32
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
IP
|
$989.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
45000295
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.70 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$761.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$771.42
|
| Rate for Payer: Cash Price |
$494.50
|
| Rate for Payer: Cigna Commercial |
$820.87
|
| Rate for Payer: First Health Commercial |
$939.55
|
| Rate for Payer: Humana Commercial |
$840.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$729.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$870.32
|
| Rate for Payer: Ohio Health Group HMO |
$741.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$860.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.41
|
| Rate for Payer: PHCS Commercial |
$949.44
|
| Rate for Payer: United Healthcare All Payer |
$870.32
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
76102573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.70 |
| Max. Negotiated Rate |
$872.64 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJ SNG DIAGTHEREPIDURCERVTHOR
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
HCPCS 62320
|
| Hospital Charge Code |
76102573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.61 |
| Max. Negotiated Rate |
$895.82 |
| Rate for Payer: Aetna Commercial |
$699.93
|
| Rate for Payer: Anthem Medicaid |
$312.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$754.47
|
| Rate for Payer: First Health Commercial |
$863.55
|
| Rate for Payer: Humana Commercial |
$772.65
|
| Rate for Payer: Humana KY Medicaid |
$312.61
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$315.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$745.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$670.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$799.92
|
| Rate for Payer: Ohio Health Group HMO |
$681.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$790.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.21
|
| Rate for Payer: PHCS Commercial |
$872.64
|
| Rate for Payer: United Healthcare All Payer |
$799.92
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(P
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761P2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.48 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$77.98
|
| Rate for Payer: Ambetter Exchange |
$35.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.48
|
| Rate for Payer: Anthem Medicaid |
$121.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.07
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$86.36
|
| Rate for Payer: Healthspan PPO |
$162.28
|
| Rate for Payer: Humana Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$124.38
|
| Rate for Payer: Molina Healthcare Passport |
$121.94
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.58
|
| Rate for Payer: UHCCP Medicaid |
$27.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.06
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(T
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761T2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem Medicaid |
$135.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Humana KY Medicaid |
$135.84
|
| Rate for Payer: Kentucky WC Medicaid |
$137.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.55
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
INJ SUPRAVALVULAR AORTOGRAPH(T
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 93567
|
| Hospital Charge Code |
761T2490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.55
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
