|
NK REJUV MOD 42MM 127/132 0^ B
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NK REJUV MOD 42MM 127/132 8^ G
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NK REJUV MOD 42MM 127/132 8^ G
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NK REJUV MOD 42MM 127/132 8^ Y
|
Facility
|
OP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem Medicaid |
$1,624.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Humana KY Medicaid |
$1,624.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,640.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NK REJUV MOD 42MM 127/132 8^ Y
|
Facility
|
IP
|
$4,723.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.06 |
| Max. Negotiated Rate |
$4,534.56 |
| Rate for Payer: Aetna Commercial |
$3,637.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,684.33
|
| Rate for Payer: Cash Price |
$2,361.75
|
| Rate for Payer: Cigna Commercial |
$3,920.50
|
| Rate for Payer: First Health Commercial |
$4,487.32
|
| Rate for Payer: Humana Commercial |
$4,014.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,873.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,485.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,417.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,156.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,542.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.28
|
| Rate for Payer: PHCS Commercial |
$4,534.56
|
| Rate for Payer: United Healthcare All Payer |
$4,156.68
|
|
|
NM liver & spleen scan wo spec
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
34000119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
NM liver & spleen scan wo spec
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
34000119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem Medicaid |
$719.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Humana KY Medicaid |
$719.44
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$726.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
NM liver & spleen scan wo spec
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
34000119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Anthem Medicaid |
$82.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,092.00
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$197.56
|
| Rate for Payer: Healthspan PPO |
$255.92
|
| Rate for Payer: Humana Medicaid |
$82.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.38
|
| Rate for Payer: Molina Healthcare Passport |
$82.73
|
| Rate for Payer: Multiplan PHCS |
$1,255.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,464.40
|
| Rate for Payer: UHCCP Medicaid |
$732.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.56
|
|
|
NM liver/spleen wo spect (P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
340P0119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$256.05 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Anthem Medicaid |
$82.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$197.56
|
| Rate for Payer: Healthspan PPO |
$255.92
|
| Rate for Payer: Humana Medicaid |
$82.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.38
|
| Rate for Payer: Molina Healthcare Passport |
$82.73
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.56
|
|
|
NM liver/spleen wo spect (T
|
Facility
|
IP
|
$2,047.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
340T0119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$266.11 |
| Max. Negotiated Rate |
$1,965.12 |
| Rate for Payer: Aetna Commercial |
$1,576.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.66
|
| Rate for Payer: Cash Price |
$1,023.50
|
| Rate for Payer: Cigna Commercial |
$1,699.01
|
| Rate for Payer: First Health Commercial |
$1,944.65
|
| Rate for Payer: Humana Commercial |
$1,739.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,801.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.57
|
| Rate for Payer: PHCS Commercial |
$1,965.12
|
| Rate for Payer: United Healthcare All Payer |
$1,801.36
|
|
|
NM liver/spleen wo spect (T
|
Facility
|
OP
|
$2,047.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
340T0119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$266.11 |
| Max. Negotiated Rate |
$1,965.12 |
| Rate for Payer: Aetna Commercial |
$1,576.19
|
| Rate for Payer: Anthem Medicaid |
$703.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,023.50
|
| Rate for Payer: Cash Price |
$1,023.50
|
| Rate for Payer: Cigna Commercial |
$1,699.01
|
| Rate for Payer: First Health Commercial |
$1,944.65
|
| Rate for Payer: Humana Commercial |
$1,739.95
|
| Rate for Payer: Humana KY Medicaid |
$703.96
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$711.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,678.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$718.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,801.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.57
|
| Rate for Payer: PHCS Commercial |
$1,965.12
|
| Rate for Payer: United Healthcare All Payer |
$1,801.36
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.63
|
| Rate for Payer: Anthem Medicaid |
$113.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,332.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$55.97
|
| Rate for Payer: Healthspan PPO |
$47.96
|
| Rate for Payer: Humana Medicaid |
$113.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.21
|
| Rate for Payer: Molina Healthcare Passport |
$113.93
|
| Rate for Payer: Multiplan PHCS |
$799.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$932.40
|
| Rate for Payer: UHCCP Medicaid |
$23.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.07
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$1,105.56
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: Humana Commercial |
$1,132.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,092.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,172.16
|
| Rate for Payer: Ohio Health Group HMO |
$999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.92
|
| Rate for Payer: PHCS Commercial |
$1,278.72
|
| Rate for Payer: United Healthcare All Payer |
$1,172.16
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$1,278.72 |
| Rate for Payer: Aetna Commercial |
$1,025.64
|
| Rate for Payer: Anthem Medicaid |
$458.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cigna Commercial |
$1,105.56
|
| Rate for Payer: First Health Commercial |
$1,265.40
|
| Rate for Payer: Humana Commercial |
$1,132.20
|
| Rate for Payer: Humana KY Medicaid |
$458.07
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$462.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,092.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$983.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$467.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,172.16
|
| Rate for Payer: Ohio Health Group HMO |
$999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.92
|
| Rate for Payer: PHCS Commercial |
$1,278.72
|
| Rate for Payer: United Healthcare All Payer |
$1,172.16
|
|
|
NM SPECT CT PARATHYROID
|
Professional
|
Both
|
$2,084.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$87.47 |
| Max. Negotiated Rate |
$2,084.00 |
| Rate for Payer: Anthem Medicaid |
$316.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,084.00
|
| Rate for Payer: Cash Price |
$1,042.00
|
| Rate for Payer: Cash Price |
$1,042.00
|
| Rate for Payer: Cigna Commercial |
$132.77
|
| Rate for Payer: Humana Medicaid |
$316.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.88
|
| Rate for Payer: Molina Healthcare Passport |
$316.55
|
| Rate for Payer: Multiplan PHCS |
$1,250.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,458.80
|
| Rate for Payer: UHCCP Medicaid |
$729.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.72
|
|
|
NM SPECT CT PARATHYROID
|
Facility
|
IP
|
$2,084.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$270.92 |
| Max. Negotiated Rate |
$2,000.64 |
| Rate for Payer: Aetna Commercial |
$1,604.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.52
|
| Rate for Payer: Cash Price |
$1,042.00
|
| Rate for Payer: Cigna Commercial |
$1,729.72
|
| Rate for Payer: First Health Commercial |
$1,979.80
|
| Rate for Payer: Humana Commercial |
$1,771.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.04
|
| Rate for Payer: PHCS Commercial |
$2,000.64
|
| Rate for Payer: United Healthcare All Payer |
$1,833.92
|
|
|
NM SPECT CT PARATHYROID
|
Facility
|
OP
|
$2,084.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$270.92 |
| Max. Negotiated Rate |
$2,000.64 |
| Rate for Payer: Aetna Commercial |
$1,604.68
|
| Rate for Payer: Anthem Medicaid |
$716.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$1,042.00
|
| Rate for Payer: Cash Price |
$1,042.00
|
| Rate for Payer: Cigna Commercial |
$1,729.72
|
| Rate for Payer: First Health Commercial |
$1,979.80
|
| Rate for Payer: Humana Commercial |
$1,771.40
|
| Rate for Payer: Humana KY Medicaid |
$716.69
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$723.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$731.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.04
|
| Rate for Payer: PHCS Commercial |
$2,000.64
|
| Rate for Payer: United Healthcare All Payer |
$1,833.92
|
|
|
NM SPECT CT PARATHYROID(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
340P0004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$322.88 |
| Rate for Payer: Anthem Medicaid |
$316.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$132.77
|
| Rate for Payer: Humana Medicaid |
$316.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.88
|
| Rate for Payer: Molina Healthcare Passport |
$316.55
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.72
|
|
|
NM SPECT CT PARATHYROID(T
|
Facility
|
OP
|
$1,884.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
340T0004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$244.92 |
| Max. Negotiated Rate |
$1,808.64 |
| Rate for Payer: Aetna Commercial |
$1,450.68
|
| Rate for Payer: Anthem Medicaid |
$647.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$1,563.72
|
| Rate for Payer: First Health Commercial |
$1,789.80
|
| Rate for Payer: Humana Commercial |
$1,601.40
|
| Rate for Payer: Humana KY Medicaid |
$647.91
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.04
|
| Rate for Payer: PHCS Commercial |
$1,808.64
|
| Rate for Payer: United Healthcare All Payer |
$1,657.92
|
|
|
NM SPECT CT PARATHYROID(T
|
Facility
|
IP
|
$1,884.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
340T0004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$244.92 |
| Max. Negotiated Rate |
$1,808.64 |
| Rate for Payer: Aetna Commercial |
$1,450.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.52
|
| Rate for Payer: Cash Price |
$942.00
|
| Rate for Payer: Cigna Commercial |
$1,563.72
|
| Rate for Payer: First Health Commercial |
$1,789.80
|
| Rate for Payer: Humana Commercial |
$1,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.04
|
| Rate for Payer: PHCS Commercial |
$1,808.64
|
| Rate for Payer: United Healthcare All Payer |
$1,657.92
|
|
|
NOLVADEX (TAMOXIFEN) 10MG/1TAB
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
25002696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.61
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna Commercial |
$1.72
|
| Rate for Payer: First Health Commercial |
$1.97
|
| Rate for Payer: Humana Commercial |
$1.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.82
|
| Rate for Payer: Ohio Health Group HMO |
$1.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Payer |
$1.82
|
|
|
NOLVADEX (TAMOXIFEN) 10MG/1TAB
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
25002696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.59
|
| Rate for Payer: Anthem Medicaid |
$0.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.61
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna Commercial |
$1.72
|
| Rate for Payer: First Health Commercial |
$1.97
|
| Rate for Payer: Humana Commercial |
$1.76
|
| Rate for Payer: Humana KY Medicaid |
$0.71
|
| Rate for Payer: Kentucky WC Medicaid |
$0.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.82
|
| Rate for Payer: Ohio Health Group HMO |
$1.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Payer |
$1.82
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$25,203.79
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$17,102.57 |
| Max. Negotiated Rate |
$25,203.79 |
| Rate for Payer: Anthem Medicaid |
$17,102.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,002.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,203.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,303.66
|
| Rate for Payer: Humana KY Medicaid |
$17,102.57
|
| Rate for Payer: Humana Medicare Advantage |
$18,002.71
|
| Rate for Payer: Kentucky WC Medicaid |
$17,273.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,603.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,444.63
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$42,545.20
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$28,869.96 |
| Max. Negotiated Rate |
$42,545.20 |
| Rate for Payer: Anthem Medicaid |
$28,869.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30,389.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$42,545.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$41,025.73
|
| Rate for Payer: Humana KY Medicaid |
$28,869.96
|
| Rate for Payer: Humana Medicare Advantage |
$30,389.43
|
| Rate for Payer: Kentucky WC Medicaid |
$29,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,467.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,447.36
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,443.95
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$10,479.82 |
| Max. Negotiated Rate |
$15,443.95 |
| Rate for Payer: Anthem Medicaid |
$10,479.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,031.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,443.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,892.38
|
| Rate for Payer: Humana KY Medicaid |
$10,479.82
|
| Rate for Payer: Humana Medicare Advantage |
$11,031.39
|
| Rate for Payer: Kentucky WC Medicaid |
$10,584.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,237.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,689.42
|
|
