|
INTRACRANIAL STUDY(T
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
320T0297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$726.72 |
| Rate for Payer: Aetna Commercial |
$582.89
|
| Rate for Payer: Anthem Medicaid |
$260.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$628.31
|
| Rate for Payer: First Health Commercial |
$719.15
|
| Rate for Payer: Humana Commercial |
$643.45
|
| Rate for Payer: Humana KY Medicaid |
$260.33
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$262.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.16
|
| Rate for Payer: Ohio Health Group HMO |
$567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$522.33
|
| Rate for Payer: PHCS Commercial |
$726.72
|
| Rate for Payer: United Healthcare All Payer |
$666.16
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
410T0107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
410T0107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
41000107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Ambetter Exchange |
$4.19
|
| Rate for Payer: Anthem Medicaid |
$4.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$9.96
|
| Rate for Payer: Healthspan PPO |
$8.20
|
| Rate for Payer: Humana Medicaid |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.08
|
| Rate for Payer: Molina Healthcare Passport |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.45
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.19
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
41000107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
410P0107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Ambetter Exchange |
$4.19
|
| Rate for Payer: Anthem Medicaid |
$4.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$9.96
|
| Rate for Payer: Healthspan PPO |
$8.20
|
| Rate for Payer: Humana Medicaid |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.08
|
| Rate for Payer: Molina Healthcare Passport |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.45
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.19
|
|
|
INTRACUANEOUS TEST SEQ & INCRE
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 95027
|
| Hospital Charge Code |
41000107
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
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 |
$11.88 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Ambetter Exchange |
$0.95
|
| 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 Individual/Medicaid |
$0.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$0.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
| 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 |
$1.24
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.95
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
41000106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Ambetter Exchange |
$0.95
|
| 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 Individual/Medicaid |
$0.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.14
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$0.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.18
|
| Rate for Payer: Molina Healthcare Passport |
$4.10
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.24
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.95
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
410T0106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.20 |
| 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 |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
41000106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.20 |
| 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 |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
410T0106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| 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: 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 |
$24.60
|
| 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 |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
INTRACUANEOU TEST W/ALLERGENIC
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
HCPCS 95024
|
| Hospital Charge Code |
41000106
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$32.33 |
| 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 |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$75.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.86
|
| Rate for Payer: PHCS Commercial |
$90.24
|
| Rate for Payer: United Healthcare All Payer |
$82.72
|
|
|
INTRAFIX TIBIAL SHEATH 30MM
|
Facility
|
IP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
INTRAFIX TIBIAL SHEATH 30MM
|
Facility
|
OP
|
$3,327.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$998.25 |
| Max. Negotiated Rate |
$3,194.40 |
| Rate for Payer: Aetna Commercial |
$2,562.18
|
| Rate for Payer: Anthem Medicaid |
$1,144.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,595.45
|
| Rate for Payer: Cash Price |
$1,663.75
|
| Rate for Payer: Cigna Commercial |
$2,761.82
|
| Rate for Payer: First Health Commercial |
$3,161.12
|
| Rate for Payer: Humana Commercial |
$2,828.38
|
| Rate for Payer: Humana KY Medicaid |
$1,144.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,728.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,167.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,928.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,495.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,662.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,894.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,295.97
|
| Rate for Payer: PHCS Commercial |
$3,194.40
|
| Rate for Payer: United Healthcare All Payer |
$2,928.20
|
|
|
INTRAFRACTION TRACK MOTION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G6017
|
| Hospital Charge Code |
33300046
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15.00 |
| 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 |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| 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 |
$15.00 |
| 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 |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
INTRALIPID 20%EMULSION(250ML)
|
Facility
|
OP
|
$204.42
|
|
|
Service Code
|
NDC 65219053325
|
| Hospital Charge Code |
25003125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$196.24 |
| Rate for Payer: Aetna Commercial |
$157.40
|
| Rate for Payer: Anthem Medicaid |
$70.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.45
|
| Rate for Payer: Cash Price |
$102.21
|
| Rate for Payer: Cigna Commercial |
$169.67
|
| Rate for Payer: First Health Commercial |
$194.20
|
| Rate for Payer: Humana Commercial |
$173.76
|
| Rate for Payer: Humana KY Medicaid |
$70.30
|
| Rate for Payer: Kentucky WC Medicaid |
$71.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.89
|
| Rate for Payer: Ohio Health Group HMO |
$153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.05
|
| Rate for Payer: PHCS Commercial |
$196.24
|
| Rate for Payer: United Healthcare All Payer |
$179.89
|
|
|
INTRALIPID 20%EMULSION(250ML)
|
Facility
|
IP
|
$204.42
|
|
|
Service Code
|
NDC 65219053325
|
| Hospital Charge Code |
25003125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$196.24 |
| Rate for Payer: Aetna Commercial |
$157.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.45
|
| Rate for Payer: Cash Price |
$102.21
|
| Rate for Payer: Cigna Commercial |
$169.67
|
| Rate for Payer: First Health Commercial |
$194.20
|
| Rate for Payer: Humana Commercial |
$173.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.89
|
| Rate for Payer: Ohio Health Group HMO |
$153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$177.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.05
|
| Rate for Payer: PHCS Commercial |
$196.24
|
| Rate for Payer: United Healthcare All Payer |
$179.89
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
320T0142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.50 |
| 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 |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
32000142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.00 |
| 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 |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
32000142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.00 |
| 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 |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
INTRALUMINAL DILATION OF STRIC
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 74360
|
| Hospital Charge Code |
320T0142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.50 |
| 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 |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
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 |
$637.00 |
| Rate for Payer: Aetna Commercial |
$240.76
|
| Rate for Payer: Anthem Medicaid |
$108.60
|
| 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
|
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: 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
|
|
