|
INTELLIS 2 TRIAL KIT INTELTRIA
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
INTELLIS 2 TRIAL KIT INTELTRIA
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
INTERACTIVE COMPLEXITY ADDT
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
90000004
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Anthem Medicaid |
$10.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$264.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$7.09
|
| Rate for Payer: Healthspan PPO |
$4.29
|
| Rate for Payer: Humana Medicaid |
$10.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.69
|
| Rate for Payer: Molina Healthcare Passport |
$10.48
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.80
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.58
|
|
|
INTERACTIVE COMPLEXITY ADDT(P
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
900P0004
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Anthem Medicaid |
$10.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$7.09
|
| Rate for Payer: Healthspan PPO |
$4.29
|
| Rate for Payer: Humana Medicaid |
$10.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.69
|
| Rate for Payer: Molina Healthcare Passport |
$10.48
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.58
|
|
|
INTERACTIVE COMPLEXITY ADDT TH
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 90785
|
| Hospital Charge Code |
51000286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Anthem Medicaid |
$10.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$264.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$7.09
|
| Rate for Payer: Healthspan PPO |
$4.29
|
| Rate for Payer: Humana Medicaid |
$10.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$7.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.69
|
| Rate for Payer: Molina Healthcare Passport |
$10.48
|
| Rate for Payer: Multiplan PHCS |
$158.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.80
|
| Rate for Payer: UHCCP Medicaid |
$92.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.58
|
|
|
INTERCEED
|
Facility
|
IP
|
$416.93
|
|
| Hospital Charge Code |
27000092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$400.25 |
| Rate for Payer: Aetna Commercial |
$321.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.21
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cigna Commercial |
$346.05
|
| Rate for Payer: First Health Commercial |
$396.08
|
| Rate for Payer: Humana Commercial |
$354.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.90
|
| Rate for Payer: Ohio Health Group HMO |
$312.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.25
|
| Rate for Payer: PHCS Commercial |
$400.25
|
| Rate for Payer: United Healthcare All Payer |
$366.90
|
|
|
INTERCEED
|
Facility
|
OP
|
$416.93
|
|
| Hospital Charge Code |
27000092
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$400.25 |
| Rate for Payer: Aetna Commercial |
$321.04
|
| Rate for Payer: Anthem Medicaid |
$143.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.21
|
| Rate for Payer: Cash Price |
$208.46
|
| Rate for Payer: Cigna Commercial |
$346.05
|
| Rate for Payer: First Health Commercial |
$396.08
|
| Rate for Payer: Humana Commercial |
$354.39
|
| Rate for Payer: Humana KY Medicaid |
$143.38
|
| Rate for Payer: Kentucky WC Medicaid |
$144.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.90
|
| Rate for Payer: Ohio Health Group HMO |
$312.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.25
|
| Rate for Payer: PHCS Commercial |
$400.25
|
| Rate for Payer: United Healthcare All Payer |
$366.90
|
|
|
INTERCOSTAL NERVE BLOCK
|
Facility
|
OP
|
$1,560.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
76102314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$1,497.60 |
| Rate for Payer: Aetna Commercial |
$1,201.20
|
| Rate for Payer: Anthem Medicaid |
$536.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,294.80
|
| Rate for Payer: First Health Commercial |
$1,482.00
|
| Rate for Payer: Humana Commercial |
$1,326.00
|
| Rate for Payer: Humana KY Medicaid |
$536.48
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$541.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,151.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,372.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.60
|
| Rate for Payer: PHCS Commercial |
$1,497.60
|
| Rate for Payer: United Healthcare All Payer |
$1,372.80
|
|
|
INTERCOSTAL NERVE BLOCK
|
Facility
|
IP
|
$1,560.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
76102314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$1,497.60 |
| Rate for Payer: Aetna Commercial |
$1,201.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,216.80
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$1,294.80
|
| Rate for Payer: First Health Commercial |
$1,482.00
|
| Rate for Payer: Humana Commercial |
$1,326.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,279.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,151.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,372.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.60
|
| Rate for Payer: PHCS Commercial |
$1,497.60
|
| Rate for Payer: United Healthcare All Payer |
$1,372.80
|
|
|
INTERCOSTAL NERVE BLOCK
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
76102314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.94
|
| Rate for Payer: Anthem Medicaid |
$47.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,560.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cigna Commercial |
$271.42
|
| Rate for Payer: Healthspan PPO |
$188.64
|
| Rate for Payer: Humana Medicaid |
$47.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.95
|
| Rate for Payer: Molina Healthcare Passport |
$47.99
|
| Rate for Payer: Multiplan PHCS |
$936.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,092.00
|
| Rate for Payer: UHCCP Medicaid |
$31.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.47
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Professional
|
Both
|
$2,313.59
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
76102315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$2,313.59 |
| Rate for Payer: Aetna Commercial |
$145.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.26
|
| Rate for Payer: Anthem Medicaid |
$20.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,313.59
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cigna Commercial |
$411.97
|
| Rate for Payer: Healthspan PPO |
$277.96
|
| Rate for Payer: Humana Medicaid |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.91
|
| Rate for Payer: Molina Healthcare Passport |
$20.50
|
| Rate for Payer: Multiplan PHCS |
$1,388.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,619.51
|
| Rate for Payer: UHCCP Medicaid |
$26.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.70
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Facility
|
IP
|
$2,313.59
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
76102315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.77 |
| Max. Negotiated Rate |
$2,221.05 |
| Rate for Payer: Aetna Commercial |
$1,781.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,804.60
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cigna Commercial |
$1,920.28
|
| Rate for Payer: First Health Commercial |
$2,197.91
|
| Rate for Payer: Humana Commercial |
$1,966.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,897.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,707.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$694.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,035.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,735.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.21
|
| Rate for Payer: PHCS Commercial |
$2,221.05
|
| Rate for Payer: United Healthcare All Payer |
$2,035.96
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
761P2315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$425.00 |
| Rate for Payer: Aetna Commercial |
$145.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.26
|
| Rate for Payer: Anthem Medicaid |
$20.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$411.97
|
| Rate for Payer: Healthspan PPO |
$277.96
|
| Rate for Payer: Humana Medicaid |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.91
|
| Rate for Payer: Molina Healthcare Passport |
$20.50
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$26.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.70
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Facility
|
OP
|
$2,313.59
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
76102315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.77 |
| Max. Negotiated Rate |
$2,221.05 |
| Rate for Payer: Aetna Commercial |
$1,781.46
|
| Rate for Payer: Anthem Medicaid |
$795.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,804.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cash Price |
$1,156.80
|
| Rate for Payer: Cigna Commercial |
$1,920.28
|
| Rate for Payer: First Health Commercial |
$2,197.91
|
| Rate for Payer: Humana Commercial |
$1,966.55
|
| Rate for Payer: Humana KY Medicaid |
$795.64
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$803.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,897.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,707.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$811.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,035.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,735.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.21
|
| Rate for Payer: PHCS Commercial |
$2,221.05
|
| Rate for Payer: United Healthcare All Payer |
$2,035.96
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Facility
|
OP
|
$1,888.59
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
761T2315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.52 |
| Max. Negotiated Rate |
$1,813.05 |
| Rate for Payer: Aetna Commercial |
$1,454.21
|
| Rate for Payer: Anthem Medicaid |
$649.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$788.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,103.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.08
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cigna Commercial |
$1,567.53
|
| Rate for Payer: First Health Commercial |
$1,794.16
|
| Rate for Payer: Humana Commercial |
$1,605.30
|
| Rate for Payer: Humana KY Medicaid |
$649.49
|
| Rate for Payer: Humana Medicare Advantage |
$788.21
|
| Rate for Payer: Kentucky WC Medicaid |
$656.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$945.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.46
|
| Rate for Payer: PHCS Commercial |
$1,813.05
|
| Rate for Payer: United Healthcare All Payer |
$1,661.96
|
|
|
INTERCOSTAL NERVE BLOCK DX MUL
|
Facility
|
IP
|
$1,888.59
|
|
|
Service Code
|
HCPCS 64421
|
| Hospital Charge Code |
761T2315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.52 |
| Max. Negotiated Rate |
$1,813.05 |
| Rate for Payer: Aetna Commercial |
$1,454.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.10
|
| Rate for Payer: Cash Price |
$944.30
|
| Rate for Payer: Cigna Commercial |
$1,567.53
|
| Rate for Payer: First Health Commercial |
$1,794.16
|
| Rate for Payer: Humana Commercial |
$1,605.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.46
|
| Rate for Payer: PHCS Commercial |
$1,813.05
|
| Rate for Payer: United Healthcare All Payer |
$1,661.96
|
|
|
INTERCOSTAL NERVE BLOCK(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
761P2314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$271.42 |
| Rate for Payer: Aetna Commercial |
$105.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.94
|
| Rate for Payer: Anthem Medicaid |
$47.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$271.42
|
| Rate for Payer: Healthspan PPO |
$188.64
|
| Rate for Payer: Humana Medicaid |
$47.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.95
|
| Rate for Payer: Molina Healthcare Passport |
$47.99
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$31.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.47
|
|
|
INTERCOSTAL NERVE BLOCK(T
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
761T2314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$1,257.60 |
| Rate for Payer: Aetna Commercial |
$1,008.70
|
| Rate for Payer: Anthem Medicaid |
$450.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,021.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cigna Commercial |
$1,087.30
|
| Rate for Payer: First Health Commercial |
$1,244.50
|
| Rate for Payer: Humana Commercial |
$1,113.50
|
| Rate for Payer: Humana KY Medicaid |
$450.51
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$455.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,074.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$966.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$459.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,152.80
|
| Rate for Payer: Ohio Health Group HMO |
$982.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.10
|
| Rate for Payer: PHCS Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Payer |
$1,152.80
|
|
|
INTERCOSTAL NERVE BLOCK(T
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 64420
|
| Hospital Charge Code |
761T2314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$1,257.60 |
| Rate for Payer: Aetna Commercial |
$1,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,021.80
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cigna Commercial |
$1,087.30
|
| Rate for Payer: First Health Commercial |
$1,244.50
|
| Rate for Payer: Humana Commercial |
$1,113.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,074.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$966.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,152.80
|
| Rate for Payer: Ohio Health Group HMO |
$982.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.10
|
| Rate for Payer: PHCS Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Payer |
$1,152.80
|
|
|
INTERLOCK 12*30
|
Facility
|
IP
|
$3,631.47
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.09 |
| Max. Negotiated Rate |
$3,486.21 |
| Rate for Payer: Aetna Commercial |
$2,796.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,832.55
|
| Rate for Payer: Cash Price |
$1,815.73
|
| Rate for Payer: Cigna Commercial |
$3,014.12
|
| Rate for Payer: First Health Commercial |
$3,449.90
|
| Rate for Payer: Humana Commercial |
$3,086.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,977.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,680.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,195.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,723.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.76
|
| Rate for Payer: PHCS Commercial |
$3,486.21
|
| Rate for Payer: United Healthcare All Payer |
$3,195.69
|
|
|
INTERLOCK 12*30
|
Facility
|
OP
|
$3,631.47
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.09 |
| Max. Negotiated Rate |
$3,486.21 |
| Rate for Payer: Aetna Commercial |
$2,796.23
|
| Rate for Payer: Anthem Medicaid |
$1,248.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,832.55
|
| Rate for Payer: Cash Price |
$1,815.73
|
| Rate for Payer: Cigna Commercial |
$3,014.12
|
| Rate for Payer: First Health Commercial |
$3,449.90
|
| Rate for Payer: Humana Commercial |
$3,086.75
|
| Rate for Payer: Humana KY Medicaid |
$1,248.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,261.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,977.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,680.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,273.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,195.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,723.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.76
|
| Rate for Payer: PHCS Commercial |
$3,486.21
|
| Rate for Payer: United Healthcare All Payer |
$3,195.69
|
|
|
INTERLOCK 14*30
|
Facility
|
OP
|
$3,631.47
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.09 |
| Max. Negotiated Rate |
$3,486.21 |
| Rate for Payer: Aetna Commercial |
$2,796.23
|
| Rate for Payer: Anthem Medicaid |
$1,248.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,832.55
|
| Rate for Payer: Cash Price |
$1,815.73
|
| Rate for Payer: Cigna Commercial |
$3,014.12
|
| Rate for Payer: First Health Commercial |
$3,449.90
|
| Rate for Payer: Humana Commercial |
$3,086.75
|
| Rate for Payer: Humana KY Medicaid |
$1,248.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,261.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,977.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,680.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,273.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,195.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,723.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.76
|
| Rate for Payer: PHCS Commercial |
$3,486.21
|
| Rate for Payer: United Healthcare All Payer |
$3,195.69
|
|
|
INTERLOCK 14*30
|
Facility
|
IP
|
$3,631.47
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$472.09 |
| Max. Negotiated Rate |
$3,486.21 |
| Rate for Payer: Aetna Commercial |
$2,796.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,832.55
|
| Rate for Payer: Cash Price |
$1,815.73
|
| Rate for Payer: Cigna Commercial |
$3,014.12
|
| Rate for Payer: First Health Commercial |
$3,449.90
|
| Rate for Payer: Humana Commercial |
$3,086.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,977.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,680.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,195.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,723.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$726.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,125.76
|
| Rate for Payer: PHCS Commercial |
$3,486.21
|
| Rate for Payer: United Healthcare All Payer |
$3,195.69
|
|
|
INTERLOCK 18*50
|
Facility
|
OP
|
$5,544.25
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.75 |
| Max. Negotiated Rate |
$5,322.48 |
| Rate for Payer: Aetna Commercial |
$4,269.07
|
| Rate for Payer: Anthem Medicaid |
$1,906.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,324.52
|
| Rate for Payer: Cash Price |
$2,772.12
|
| Rate for Payer: Cigna Commercial |
$4,601.73
|
| Rate for Payer: First Health Commercial |
$5,267.04
|
| Rate for Payer: Humana Commercial |
$4,712.61
|
| Rate for Payer: Humana KY Medicaid |
$1,906.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,926.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,546.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,091.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,944.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,878.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,158.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,108.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,718.72
|
| Rate for Payer: PHCS Commercial |
$5,322.48
|
| Rate for Payer: United Healthcare All Payer |
$4,878.94
|
|
|
INTERLOCK 18*50
|
Facility
|
IP
|
$5,544.25
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$720.75 |
| Max. Negotiated Rate |
$5,322.48 |
| Rate for Payer: Aetna Commercial |
$4,269.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,324.52
|
| Rate for Payer: Cash Price |
$2,772.12
|
| Rate for Payer: Cigna Commercial |
$4,601.73
|
| Rate for Payer: First Health Commercial |
$5,267.04
|
| Rate for Payer: Humana Commercial |
$4,712.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,546.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,091.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,663.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,878.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,158.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,108.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$720.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,718.72
|
| Rate for Payer: PHCS Commercial |
$5,322.48
|
| Rate for Payer: United Healthcare All Payer |
$4,878.94
|
|
