|
NK REJUV MOD 42MM 127/132 0^ B
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 42MM 127/132 8^ G
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 42MM 127/132 8^ G
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 42MM 127/132 8^ Y
|
Facility
|
OP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem Medicaid |
$1,617.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Humana KY Medicaid |
$1,617.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,634.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,650.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
NK REJUV MOD 42MM 127/132 8^ Y
|
Facility
|
IP
|
$4,703.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.12 |
| Max. Negotiated Rate |
$4,515.60 |
| Rate for Payer: Aetna Commercial |
$3,621.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,668.93
|
| Rate for Payer: Cash Price |
$2,351.88
|
| Rate for Payer: Cigna Commercial |
$3,904.11
|
| Rate for Payer: First Health Commercial |
$4,468.56
|
| Rate for Payer: Humana Commercial |
$3,998.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,857.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,471.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,411.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,139.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,527.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,763.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,092.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,245.59
|
| Rate for Payer: PHCS Commercial |
$4,515.60
|
| Rate for Payer: United Healthcare All Payer |
$4,139.30
|
|
|
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 |
$1,255.20 |
| Rate for Payer: Aetna Commercial |
$256.05
|
| Rate for Payer: Ambetter Exchange |
$156.21
|
| Rate for Payer: Anthem Medicaid |
$82.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$156.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$156.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$187.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$156.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.21
|
| 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 |
$203.07
|
| Rate for Payer: UHCCP Medicaid |
$732.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$156.21
|
|
|
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 |
$497.35 |
| 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 |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| 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 |
$497.35
|
| 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 |
$596.82
|
| 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 |
$1,673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.48
|
| 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
|
IP
|
$2,092.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
34000119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$627.60 |
| 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 |
$1,673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.48
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
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: Ambetter Exchange |
$156.21
|
| Rate for Payer: Anthem Medicaid |
$82.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$156.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$156.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$187.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$156.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.21
|
| 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 |
$203.07
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$156.21
|
|
|
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 |
$497.35 |
| 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 |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| 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 |
$497.35
|
| 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 |
$596.82
|
| 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 |
$1,637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,780.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.43
|
| 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
|
IP
|
$2,047.00
|
|
|
Service Code
|
HCPCS 78201
|
| Hospital Charge Code |
340T0119
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$614.10 |
| 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 |
$1,637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,780.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,412.43
|
| Rate for Payer: PHCS Commercial |
$1,965.12
|
| Rate for Payer: United Healthcare All Payer |
$1,801.36
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$1,313.28 |
| Rate for Payer: Aetna Commercial |
$1,053.36
|
| Rate for Payer: Anthem Medicaid |
$470.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$1,135.44
|
| Rate for Payer: First Health Commercial |
$1,299.60
|
| Rate for Payer: Humana Commercial |
$1,162.80
|
| Rate for Payer: Humana KY Medicaid |
$470.46
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$475.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,121.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,009.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$479.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,203.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,094.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.92
|
| Rate for Payer: PHCS Commercial |
$1,313.28
|
| Rate for Payer: United Healthcare All Payer |
$1,203.84
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$410.40 |
| Max. Negotiated Rate |
$1,313.28 |
| Rate for Payer: Aetna Commercial |
$1,053.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,067.04
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cigna Commercial |
$1,135.44
|
| Rate for Payer: First Health Commercial |
$1,299.60
|
| Rate for Payer: Humana Commercial |
$1,162.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,121.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,009.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$410.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,203.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,094.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$943.92
|
| Rate for Payer: PHCS Commercial |
$1,313.28
|
| Rate for Payer: United Healthcare All Payer |
$1,203.84
|
|
|
NM SENTINOL NODE INJECT MELANO
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 38792
|
| Hospital Charge Code |
34000118
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$820.80 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Ambetter Exchange |
$30.14
|
| 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 Individual/Medicaid |
$30.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.17
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.21
|
| Rate for Payer: Molina Healthcare Passport |
$113.93
|
| Rate for Payer: Multiplan PHCS |
$820.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.18
|
| Rate for Payer: UHCCP Medicaid |
$23.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.14
|
|
|
NM SPECT CT PARATHYROID
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$87.47 |
| Max. Negotiated Rate |
$1,324.20 |
| Rate for Payer: Ambetter Exchange |
$348.93
|
| Rate for Payer: Anthem Medicaid |
$316.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.72
|
| Rate for Payer: Cash Price |
$1,103.50
|
| Rate for Payer: Cash Price |
$1,103.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$348.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.88
|
| Rate for Payer: Molina Healthcare Passport |
$316.55
|
| Rate for Payer: Multiplan PHCS |
$1,324.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$453.61
|
| Rate for Payer: UHCCP Medicaid |
$772.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.93
|
|
|
NM SPECT CT PARATHYROID
|
Facility
|
OP
|
$2,207.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$2,118.72 |
| Rate for Payer: Aetna Commercial |
$1,699.39
|
| Rate for Payer: Anthem Medicaid |
$758.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,103.50
|
| Rate for Payer: Cash Price |
$1,103.50
|
| Rate for Payer: Cigna Commercial |
$1,831.81
|
| Rate for Payer: First Health Commercial |
$2,096.65
|
| Rate for Payer: Humana Commercial |
$1,875.95
|
| Rate for Payer: Humana KY Medicaid |
$758.99
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$766.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,809.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,628.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,920.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.83
|
| Rate for Payer: PHCS Commercial |
$2,118.72
|
| Rate for Payer: United Healthcare All Payer |
$1,942.16
|
|
|
NM SPECT CT PARATHYROID
|
Facility
|
IP
|
$2,207.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
34000004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$662.10 |
| Max. Negotiated Rate |
$2,118.72 |
| Rate for Payer: Aetna Commercial |
$1,699.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.46
|
| Rate for Payer: Cash Price |
$1,103.50
|
| Rate for Payer: Cigna Commercial |
$1,831.81
|
| Rate for Payer: First Health Commercial |
$2,096.65
|
| Rate for Payer: Humana Commercial |
$1,875.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,809.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,628.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,920.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.83
|
| Rate for Payer: PHCS Commercial |
$2,118.72
|
| Rate for Payer: United Healthcare All Payer |
$1,942.16
|
|
|
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 |
$453.61 |
| Rate for Payer: Ambetter Exchange |
$348.93
|
| Rate for Payer: Anthem Medicaid |
$316.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$348.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$348.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$418.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$348.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.93
|
| 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 |
$453.61
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$348.93
|
|
|
NM SPECT CT PARATHYROID(T
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
340T0004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$1,926.72 |
| Rate for Payer: Aetna Commercial |
$1,545.39
|
| Rate for Payer: Anthem Medicaid |
$690.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,565.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,665.81
|
| Rate for Payer: First Health Commercial |
$1,906.65
|
| Rate for Payer: Humana Commercial |
$1,705.95
|
| Rate for Payer: Humana KY Medicaid |
$690.21
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$697.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,645.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,766.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,746.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.83
|
| Rate for Payer: PHCS Commercial |
$1,926.72
|
| Rate for Payer: United Healthcare All Payer |
$1,766.16
|
|
|
NM SPECT CT PARATHYROID(T
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
HCPCS 78072
|
| Hospital Charge Code |
340T0004
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$602.10 |
| Max. Negotiated Rate |
$1,926.72 |
| Rate for Payer: Aetna Commercial |
$1,545.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,565.46
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,665.81
|
| Rate for Payer: First Health Commercial |
$1,906.65
|
| Rate for Payer: Humana Commercial |
$1,705.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,645.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,766.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,746.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.83
|
| Rate for Payer: PHCS Commercial |
$1,926.72
|
| Rate for Payer: United Healthcare All Payer |
$1,766.16
|
|
|
NOLVADEX (TAMOXIFEN) 10MG/1TAB
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
25002696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| 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 |
$1.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| 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 |
$0.62 |
| 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 |
$1.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$1.99
|
| Rate for Payer: United Healthcare All Payer |
$1.82
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.99
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
NON-GYN LIQUID CYTOLOGY
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 88112
|
| Hospital Charge Code |
30001418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.23 |
| Max. Negotiated Rate |
$155.01 |
| Rate for Payer: Aetna Commercial |
$155.01
|
| Rate for Payer: Ambetter Exchange |
$61.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.81
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$72.53
|
| Rate for Payer: Healthspan PPO |
$147.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.51
|
| Rate for Payer: Multiplan PHCS |
$102.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.96
|
| Rate for Payer: UHCCP Medicaid |
$59.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.51
|
|
