|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
41000106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
41000106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$90.24 |
| Rate for Payer: Aetna Commercial |
$72.38
|
| Rate for Payer: Anthem Medicaid |
$32.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$78.02
|
| Rate for Payer: First Health Commercial |
$89.30
|
| Rate for Payer: Humana Commercial |
$79.90
|
| Rate for Payer: Humana KY Medicaid |
$32.33
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$32.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$82.72
|
| Rate for Payer: Ohio Health Group HMO |
$70.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.14
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
410P0106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$0.86
|
| Rate for Payer: Anthem Medicaid |
$4.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$9.96
|
| Rate for Payer: Healthspan PPO |
$11.88
|
| Rate for Payer: Humana Medicaid |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.18
|
| Rate for Payer: Molina Healthcare Passport |
$4.10
|
| Rate for Payer: Multiplan PHCS |
$7.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.40
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.14
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
410T0106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
INTRAFIX TIBIAL SHEATH 30MM
|
Facility
|
OP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem Medicaid |
$1,182.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Humana KY Medicaid |
$1,182.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
INTRAFIX TIBIAL SHEATH 30MM
|
Facility
|
IP
|
$3,439.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$3,301.44 |
| Rate for Payer: Aetna Commercial |
$2,648.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,682.42
|
| Rate for Payer: Cash Price |
$1,719.50
|
| Rate for Payer: Cigna Commercial |
$2,854.37
|
| Rate for Payer: First Health Commercial |
$3,267.05
|
| Rate for Payer: Humana Commercial |
$2,923.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,819.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,537.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,026.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,579.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.09
|
| Rate for Payer: PHCS Commercial |
$3,301.44
|
| Rate for Payer: United Healthcare All Payer |
$3,026.32
|
|
|
INTRAFRACTION TRACK MOTION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G6017
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
INTRAFRACTION TRACK MOTION
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G6017
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
INTRALIPID 20%EMULSION(250ML)
|
Facility
|
IP
|
$200.04
|
|
|
Service Code
|
NDC 65219053325
|
| Hospital Charge Code |
25003125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$192.04 |
| Rate for Payer: Aetna Commercial |
$154.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.03
|
| Rate for Payer: Cash Price |
$100.02
|
| Rate for Payer: Cigna Commercial |
$166.03
|
| Rate for Payer: First Health Commercial |
$190.04
|
| Rate for Payer: Humana Commercial |
$170.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.04
|
| Rate for Payer: Ohio Health Group HMO |
$150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.01
|
| Rate for Payer: PHCS Commercial |
$192.04
|
| Rate for Payer: United Healthcare All Payer |
$176.04
|
|
|
INTRALIPID 20%EMULSION(250ML)
|
Facility
|
OP
|
$200.04
|
|
|
Service Code
|
NDC 65219053325
|
| Hospital Charge Code |
25003125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$192.04 |
| Rate for Payer: Aetna Commercial |
$154.03
|
| Rate for Payer: Anthem Medicaid |
$68.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.03
|
| Rate for Payer: Cash Price |
$100.02
|
| Rate for Payer: Cigna Commercial |
$166.03
|
| Rate for Payer: First Health Commercial |
$190.04
|
| Rate for Payer: Humana Commercial |
$170.03
|
| Rate for Payer: Humana KY Medicaid |
$68.79
|
| Rate for Payer: Kentucky WC Medicaid |
$69.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.04
|
| Rate for Payer: Ohio Health Group HMO |
$150.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.01
|
| Rate for Payer: PHCS Commercial |
$192.04
|
| Rate for Payer: United Healthcare All Payer |
$176.04
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
32000142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.10
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Professional
|
Both
|
$910.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
32000142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$910.00 |
| Rate for Payer: Aetna Commercial |
$240.76
|
| Rate for Payer: Anthem Medicaid |
$108.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$910.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$232.15
|
| Rate for Payer: Healthspan PPO |
$136.46
|
| Rate for Payer: Humana Medicaid |
$108.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.77
|
| Rate for Payer: Molina Healthcare Passport |
$108.60
|
| Rate for Payer: Multiplan PHCS |
$546.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$637.00
|
| Rate for Payer: UHCCP Medicaid |
$318.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.69
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
32000142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.10
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
320T0142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.35
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
320T0142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.35
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
320P0142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$240.76 |
| Rate for Payer: Aetna Commercial |
$240.76
|
| Rate for Payer: Anthem Medicaid |
$108.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$232.15
|
| Rate for Payer: Healthspan PPO |
$136.46
|
| Rate for Payer: Humana Medicaid |
$108.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.77
|
| Rate for Payer: Molina Healthcare Passport |
$108.60
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.69
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$21,417.10
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$14,533.03 |
| Max. Negotiated Rate |
$21,417.10 |
| Rate for Payer: Anthem Medicaid |
$14,533.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,297.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,417.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,652.21
|
| Rate for Payer: Humana KY Medicaid |
$14,533.03
|
| Rate for Payer: Humana Medicare Advantage |
$15,297.93
|
| Rate for Payer: Kentucky WC Medicaid |
$14,678.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,357.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,823.69
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,019.14
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$9,512.99 |
| Max. Negotiated Rate |
$14,019.14 |
| Rate for Payer: Anthem Medicaid |
$9,512.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,013.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,019.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,518.45
|
| Rate for Payer: Humana KY Medicaid |
$9,512.99
|
| Rate for Payer: Humana Medicare Advantage |
$10,013.67
|
| Rate for Payer: Kentucky WC Medicaid |
$9,608.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,016.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,703.25
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.19 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Anthem Medicaid |
$65.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$57.26
|
| Rate for Payer: Healthspan PPO |
$134.20
|
| Rate for Payer: Humana Medicaid |
$65.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.53
|
| Rate for Payer: Molina Healthcare Passport |
$65.23
|
| Rate for Payer: Multiplan PHCS |
$165.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$193.20
|
| Rate for Payer: UHCCP Medicaid |
$96.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.88
|
|
|
INTRAOP CYTO PATH CONSULT 1
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 88333
|
| Hospital Charge Code |
30001582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$1,041.03 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$94.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$743.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,041.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,003.85
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$94.92
|
| Rate for Payer: Humana Medicare Advantage |
$743.59
|
| Rate for Payer: Kentucky WC Medicaid |
$95.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.56
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
INTRAORAL BIOPSY OF MAX SINU(P
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
761P1160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$673.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$673.00
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$403.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$471.10
|
| Rate for Payer: UHCCP Medicaid |
$235.55
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Facility
|
IP
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.26 |
| Max. Negotiated Rate |
$3,827.18 |
| Rate for Payer: Aetna Commercial |
$3,069.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.59
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cigna Commercial |
$3,308.92
|
| Rate for Payer: First Health Commercial |
$3,787.32
|
| Rate for Payer: Humana Commercial |
$3,388.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.86
|
| Rate for Payer: PHCS Commercial |
$3,827.18
|
| Rate for Payer: United Healthcare All Payer |
$3,508.25
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Professional
|
Both
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,986.65 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,986.65
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,391.99
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,790.66
|
| Rate for Payer: UHCCP Medicaid |
$1,395.33
|
|
|
INTRAORAL BIOPSY OF MAX SINUS
|
Facility
|
OP
|
$3,986.65
|
|
|
Service Code
|
HCPCS 31299
|
| Hospital Charge Code |
76101160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.23 |
| Max. Negotiated Rate |
$3,827.18 |
| Rate for Payer: Aetna Commercial |
$3,069.72
|
| Rate for Payer: Anthem Medicaid |
$1,371.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cash Price |
$1,993.33
|
| Rate for Payer: Cigna Commercial |
$3,308.92
|
| Rate for Payer: First Health Commercial |
$3,787.32
|
| Rate for Payer: Humana Commercial |
$3,388.65
|
| Rate for Payer: Humana KY Medicaid |
$1,371.01
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.86
|
| Rate for Payer: PHCS Commercial |
$3,827.18
|
| Rate for Payer: United Healthcare All Payer |
$3,508.25
|
|
