|
PERMANENT PACEMAKER(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
761P1243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$840.20
|
| Rate for Payer: Anthem Medicaid |
$487.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$855.41
|
| Rate for Payer: Healthspan PPO |
$826.08
|
| Rate for Payer: Humana Medicaid |
$487.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$687.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.35
|
| Rate for Payer: Molina Healthcare Passport |
$487.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.48
|
|
|
PER PM REEVAL EST PAT 65+ Y(P
|
Professional
|
Both
|
$426.57
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
510P0109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$426.57 |
| Rate for Payer: Aetna Commercial |
$135.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.05
|
| Rate for Payer: Anthem Medicaid |
$81.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.57
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: Healthspan PPO |
$137.26
|
| Rate for Payer: Humana Medicaid |
$81.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.81
|
| Rate for Payer: Molina Healthcare Passport |
$81.19
|
| Rate for Payer: Multiplan PHCS |
$255.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$298.60
|
| Rate for Payer: UHCCP Medicaid |
$53.60
|
| Rate for Payer: United Healthcare Non-Options |
$93.05
|
| Rate for Payer: United Healthcare Options |
$76.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.00
|
|
|
PER PM REEVAL EST PAT 65+ YR
|
Facility
|
OP
|
$426.57
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
51000109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.45 |
| Max. Negotiated Rate |
$409.51 |
| Rate for Payer: Aetna Commercial |
$328.46
|
| Rate for Payer: Anthem Medicaid |
$146.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.72
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cigna Commercial |
$354.05
|
| Rate for Payer: First Health Commercial |
$405.24
|
| Rate for Payer: Humana Commercial |
$362.58
|
| Rate for Payer: Humana KY Medicaid |
$146.70
|
| Rate for Payer: Kentucky WC Medicaid |
$148.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.38
|
| Rate for Payer: Ohio Health Group HMO |
$319.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.24
|
| Rate for Payer: PHCS Commercial |
$409.51
|
| Rate for Payer: United Healthcare All Payer |
$375.38
|
|
|
PER PM REEVAL EST PAT 65+ YR
|
Professional
|
Both
|
$426.57
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
51000109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.05 |
| Max. Negotiated Rate |
$426.57 |
| Rate for Payer: Aetna Commercial |
$135.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.05
|
| Rate for Payer: Anthem Medicaid |
$81.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.57
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: Healthspan PPO |
$137.26
|
| Rate for Payer: Humana Medicaid |
$81.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.81
|
| Rate for Payer: Molina Healthcare Passport |
$81.19
|
| Rate for Payer: Multiplan PHCS |
$255.94
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$298.60
|
| Rate for Payer: UHCCP Medicaid |
$53.60
|
| Rate for Payer: United Healthcare Non-Options |
$93.05
|
| Rate for Payer: United Healthcare Options |
$76.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.00
|
|
|
PER PM REEVAL EST PAT 65+ YR
|
Facility
|
IP
|
$426.57
|
|
|
Service Code
|
HCPCS 99397
|
| Hospital Charge Code |
51000109
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.45 |
| Max. Negotiated Rate |
$409.51 |
| Rate for Payer: Aetna Commercial |
$328.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.72
|
| Rate for Payer: Cash Price |
$213.28
|
| Rate for Payer: Cigna Commercial |
$354.05
|
| Rate for Payer: First Health Commercial |
$405.24
|
| Rate for Payer: Humana Commercial |
$362.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.38
|
| Rate for Payer: Ohio Health Group HMO |
$319.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.24
|
| Rate for Payer: PHCS Commercial |
$409.51
|
| Rate for Payer: United Healthcare All Payer |
$375.38
|
|
|
PERQ ACCESS & CLSR FEM ART
|
Facility
|
OP
|
$5,688.50
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
76101351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.50 |
| Max. Negotiated Rate |
$5,460.96 |
| Rate for Payer: Aetna Commercial |
$4,380.14
|
| Rate for Payer: Anthem Medicaid |
$1,956.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.03
|
| Rate for Payer: Cash Price |
$2,844.25
|
| Rate for Payer: Cigna Commercial |
$4,721.46
|
| Rate for Payer: First Health Commercial |
$5,404.08
|
| Rate for Payer: Humana Commercial |
$4,835.22
|
| Rate for Payer: Humana KY Medicaid |
$1,956.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,995.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,005.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.44
|
| Rate for Payer: PHCS Commercial |
$5,460.96
|
| Rate for Payer: United Healthcare All Payer |
$5,005.88
|
|
|
PERQ ACCESS & CLSR FEM ART
|
Facility
|
IP
|
$5,688.50
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
76101351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.50 |
| Max. Negotiated Rate |
$5,460.96 |
| Rate for Payer: Aetna Commercial |
$4,380.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.03
|
| Rate for Payer: Cash Price |
$2,844.25
|
| Rate for Payer: Cigna Commercial |
$4,721.46
|
| Rate for Payer: First Health Commercial |
$5,404.08
|
| Rate for Payer: Humana Commercial |
$4,835.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,664.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,198.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,706.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,005.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,266.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,137.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,763.44
|
| Rate for Payer: PHCS Commercial |
$5,460.96
|
| Rate for Payer: United Healthcare All Payer |
$5,005.88
|
|
|
PERQ ACCESS & CLSR FEM ART
|
Professional
|
Both
|
$5,688.50
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
76101351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$5,688.50 |
| Rate for Payer: Anthem Medicaid |
$103.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,688.50
|
| Rate for Payer: Cash Price |
$2,844.25
|
| Rate for Payer: Cash Price |
$2,844.25
|
| Rate for Payer: Cigna Commercial |
$237.09
|
| Rate for Payer: Humana Medicaid |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.77
|
| Rate for Payer: Molina Healthcare Passport |
$103.70
|
| Rate for Payer: Multiplan PHCS |
$3,413.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,981.95
|
| Rate for Payer: UHCCP Medicaid |
$1,990.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.74
|
|
|
PERQ ACCESS & CLSR FEM ART(P
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
761P1351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Anthem Medicaid |
$103.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$237.09
|
| Rate for Payer: Humana Medicaid |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.77
|
| Rate for Payer: Molina Healthcare Passport |
$103.70
|
| Rate for Payer: Multiplan PHCS |
$198.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$231.00
|
| Rate for Payer: UHCCP Medicaid |
$115.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.74
|
|
|
PERQ ACCESS & CLSR FEM ART(T
|
Facility
|
IP
|
$5,358.50
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
761T1351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.60 |
| Max. Negotiated Rate |
$5,144.16 |
| Rate for Payer: Aetna Commercial |
$4,126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,179.63
|
| Rate for Payer: Cash Price |
$2,679.25
|
| Rate for Payer: Cigna Commercial |
$4,447.56
|
| Rate for Payer: First Health Commercial |
$5,090.58
|
| Rate for Payer: Humana Commercial |
$4,554.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,954.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,607.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,715.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,018.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,071.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,661.14
|
| Rate for Payer: PHCS Commercial |
$5,144.16
|
| Rate for Payer: United Healthcare All Payer |
$4,715.48
|
|
|
PERQ ACCESS & CLSR FEM ART(T
|
Facility
|
OP
|
$5,358.50
|
|
|
Service Code
|
HCPCS 34713
|
| Hospital Charge Code |
761T1351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.60 |
| Max. Negotiated Rate |
$5,144.16 |
| Rate for Payer: Aetna Commercial |
$4,126.04
|
| Rate for Payer: Anthem Medicaid |
$1,842.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,179.63
|
| Rate for Payer: Cash Price |
$2,679.25
|
| Rate for Payer: Cigna Commercial |
$4,447.56
|
| Rate for Payer: First Health Commercial |
$5,090.58
|
| Rate for Payer: Humana Commercial |
$4,554.72
|
| Rate for Payer: Humana KY Medicaid |
$1,842.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,861.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,393.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,954.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,607.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,879.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,715.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,018.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,071.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,661.14
|
| Rate for Payer: PHCS Commercial |
$5,144.16
|
| Rate for Payer: United Healthcare All Payer |
$4,715.48
|
|
|
PERQ CERVICOTHORACIC INJECT
|
Professional
|
Both
|
$11,085.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.63 |
| Max. Negotiated Rate |
$11,085.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$354.63
|
| Rate for Payer: Anthem Medicaid |
$368.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,085.00
|
| Rate for Payer: Cash Price |
$5,542.50
|
| Rate for Payer: Cash Price |
$5,542.50
|
| Rate for Payer: Cigna Commercial |
$858.27
|
| Rate for Payer: Humana Medicaid |
$368.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.36
|
| Rate for Payer: Molina Healthcare Passport |
$368.00
|
| Rate for Payer: Multiplan PHCS |
$6,651.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,759.50
|
| Rate for Payer: UHCCP Medicaid |
$372.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.68
|
|
|
PERQ CERVICOTHORACIC INJECT
|
Facility
|
IP
|
$11,085.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,441.05 |
| Max. Negotiated Rate |
$10,641.60 |
| Rate for Payer: Aetna Commercial |
$8,535.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,646.30
|
| Rate for Payer: Cash Price |
$5,542.50
|
| Rate for Payer: Cigna Commercial |
$9,200.55
|
| Rate for Payer: First Health Commercial |
$10,530.75
|
| Rate for Payer: Humana Commercial |
$9,422.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,325.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,441.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.35
|
| Rate for Payer: PHCS Commercial |
$10,641.60
|
| Rate for Payer: United Healthcare All Payer |
$9,754.80
|
|
|
PERQ CERVICOTHORACIC INJECT
|
Facility
|
OP
|
$11,085.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,441.05 |
| Max. Negotiated Rate |
$10,641.60 |
| Rate for Payer: Aetna Commercial |
$8,535.45
|
| Rate for Payer: Anthem Medicaid |
$3,812.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,646.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$5,542.50
|
| Rate for Payer: Cash Price |
$5,542.50
|
| Rate for Payer: Cigna Commercial |
$9,200.55
|
| Rate for Payer: First Health Commercial |
$10,530.75
|
| Rate for Payer: Humana Commercial |
$9,422.25
|
| Rate for Payer: Humana KY Medicaid |
$3,812.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,850.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,089.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,180.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,888.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,754.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,441.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,436.35
|
| Rate for Payer: PHCS Commercial |
$10,641.60
|
| Rate for Payer: United Healthcare All Payer |
$9,754.80
|
|
|
PERQ CERVICOTHORACIC INJECT(P
|
Professional
|
Both
|
$3,650.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
761P0421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.63 |
| Max. Negotiated Rate |
$3,650.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$354.63
|
| Rate for Payer: Anthem Medicaid |
$368.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,650.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$858.27
|
| Rate for Payer: Humana Medicaid |
$368.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.36
|
| Rate for Payer: Molina Healthcare Passport |
$368.00
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,555.00
|
| Rate for Payer: UHCCP Medicaid |
$372.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.68
|
|
|
PERQ CERVICOTHORACIC INJECT(T
|
Facility
|
IP
|
$7,435.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
761T0421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$966.55 |
| Max. Negotiated Rate |
$7,137.60 |
| Rate for Payer: Aetna Commercial |
$5,724.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,799.30
|
| Rate for Payer: Cash Price |
$3,717.50
|
| Rate for Payer: Cigna Commercial |
$6,171.05
|
| Rate for Payer: First Health Commercial |
$7,063.25
|
| Rate for Payer: Humana Commercial |
$6,319.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,096.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,487.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,230.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,576.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,487.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$966.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.85
|
| Rate for Payer: PHCS Commercial |
$7,137.60
|
| Rate for Payer: United Healthcare All Payer |
$6,542.80
|
|
|
PERQ CERVICOTHORACIC INJECT(T
|
Facility
|
OP
|
$7,435.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
761T0421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$966.55 |
| Max. Negotiated Rate |
$7,137.60 |
| Rate for Payer: Aetna Commercial |
$5,724.95
|
| Rate for Payer: Anthem Medicaid |
$2,556.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,799.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$3,717.50
|
| Rate for Payer: Cash Price |
$3,717.50
|
| Rate for Payer: Cigna Commercial |
$6,171.05
|
| Rate for Payer: First Health Commercial |
$7,063.25
|
| Rate for Payer: Humana Commercial |
$6,319.75
|
| Rate for Payer: Humana KY Medicaid |
$2,556.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,582.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,096.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,487.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,608.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,576.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,487.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$966.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.85
|
| Rate for Payer: PHCS Commercial |
$7,137.60
|
| Rate for Payer: United Healthcare All Payer |
$6,542.80
|
|
|
PERQ DEV BREAST 1ST STRTCTC
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$2,169.60 |
| Rate for Payer: Aetna Commercial |
$1,740.20
|
| Rate for Payer: Anthem Medicaid |
$777.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,762.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cigna Commercial |
$1,875.80
|
| Rate for Payer: First Health Commercial |
$2,147.00
|
| Rate for Payer: Humana Commercial |
$1,921.00
|
| Rate for Payer: Humana KY Medicaid |
$777.21
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$785.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,853.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,667.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$792.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,988.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.60
|
| Rate for Payer: PHCS Commercial |
$2,169.60
|
| Rate for Payer: United Healthcare All Payer |
$1,988.80
|
|
|
PERQ DEV BREAST 1ST STRTCTC
|
Professional
|
Both
|
$2,260.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$83.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,260.00
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cigna Commercial |
$436.46
|
| Rate for Payer: Healthspan PPO |
$338.44
|
| Rate for Payer: Humana Medicaid |
$83.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.29
|
| Rate for Payer: Molina Healthcare Passport |
$83.62
|
| Rate for Payer: Multiplan PHCS |
$1,356.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,582.00
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.46
|
|
|
PERQ DEV BREAST 1ST STRTCTC
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.80 |
| Max. Negotiated Rate |
$2,169.60 |
| Rate for Payer: Aetna Commercial |
$1,740.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,762.80
|
| Rate for Payer: Cash Price |
$1,130.00
|
| Rate for Payer: Cigna Commercial |
$1,875.80
|
| Rate for Payer: First Health Commercial |
$2,147.00
|
| Rate for Payer: Humana Commercial |
$1,921.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,853.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,667.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,988.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,695.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.60
|
| Rate for Payer: PHCS Commercial |
$2,169.60
|
| Rate for Payer: United Healthcare All Payer |
$1,988.80
|
|
|
PERQ DEV BREAST 1ST STRTCTC(P
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761P0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$436.46 |
| Rate for Payer: Cigna Commercial |
$436.46
|
| Rate for Payer: Healthspan PPO |
$338.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$83.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Humana Medicaid |
$83.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.29
|
| Rate for Payer: Molina Healthcare Passport |
$83.62
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.46
|
|
|
PERQ DEV BREAST 1ST STRTCTC(T
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761T0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.85 |
| Max. Negotiated Rate |
$1,963.20 |
| Rate for Payer: Aetna Commercial |
$1,574.65
|
| Rate for Payer: Anthem Medicaid |
$703.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cigna Commercial |
$1,697.35
|
| Rate for Payer: First Health Commercial |
$1,942.75
|
| Rate for Payer: Humana Commercial |
$1,738.25
|
| Rate for Payer: Humana KY Medicaid |
$703.28
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$710.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,676.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,799.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,533.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.95
|
| Rate for Payer: PHCS Commercial |
$1,963.20
|
| Rate for Payer: United Healthcare All Payer |
$1,799.60
|
|
|
PERQ DEV BREAST 1ST STRTCTC(T
|
Facility
|
IP
|
$2,045.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
761T0294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.85 |
| Max. Negotiated Rate |
$1,963.20 |
| Rate for Payer: Aetna Commercial |
$1,574.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.10
|
| Rate for Payer: Cash Price |
$1,022.50
|
| Rate for Payer: Cigna Commercial |
$1,697.35
|
| Rate for Payer: First Health Commercial |
$1,942.75
|
| Rate for Payer: Humana Commercial |
$1,738.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,676.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,799.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,533.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$633.95
|
| Rate for Payer: PHCS Commercial |
$1,963.20
|
| Rate for Payer: United Healthcare All Payer |
$1,799.60
|
|
|
PERQ DEV BREAST 1ST US IMAG
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.42 |
| Max. Negotiated Rate |
$2,815.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.42
|
| Rate for Payer: Anthem Medicaid |
$70.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,815.00
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cigna Commercial |
$731.66
|
| Rate for Payer: Healthspan PPO |
$565.24
|
| Rate for Payer: Humana Medicaid |
$70.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.35
|
| Rate for Payer: Molina Healthcare Passport |
$70.93
|
| Rate for Payer: Multiplan PHCS |
$1,689.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,970.50
|
| Rate for Payer: UHCCP Medicaid |
$70.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.64
|
|
|
PERQ DEV BREAST 1ST US IMAG
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
HCPCS 19285
|
| Hospital Charge Code |
76100295
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.95 |
| Max. Negotiated Rate |
$2,702.40 |
| Rate for Payer: Aetna Commercial |
$2,167.55
|
| Rate for Payer: Anthem Medicaid |
$968.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,195.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cash Price |
$1,407.50
|
| Rate for Payer: Cigna Commercial |
$2,336.45
|
| Rate for Payer: First Health Commercial |
$2,674.25
|
| Rate for Payer: Humana Commercial |
$2,392.75
|
| Rate for Payer: Humana KY Medicaid |
$968.08
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$977.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,308.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,077.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$987.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,477.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$563.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.65
|
| Rate for Payer: PHCS Commercial |
$2,702.40
|
| Rate for Payer: United Healthcare All Payer |
$2,477.20
|
|
