|
PERMANENT NAIL REMOVAL
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
PERMANENT NAIL REMOVAL(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761P0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$270.66 |
| Rate for Payer: Aetna Commercial |
$251.62
|
| Rate for Payer: Ambetter Exchange |
$95.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.81
|
| Rate for Payer: Anthem Medicaid |
$109.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$95.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$95.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.64
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$270.66
|
| Rate for Payer: Healthspan PPO |
$238.86
|
| Rate for Payer: Humana Medicaid |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$95.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$111.84
|
| Rate for Payer: Molina Healthcare Passport |
$109.65
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$124.19
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$110.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$95.53
|
|
|
PERMANENT NAIL REMOVAL(T
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761T0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
PERMANENT NAIL REMOVAL(T
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761T0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
PERMANENT PACEMAKER
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
PERMANENT PACEMAKER
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
PERMANENT PACEMAKER
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$840.20
|
| Rate for Payer: Ambetter Exchange |
$447.00
|
| Rate for Payer: Anthem Medicaid |
$487.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$447.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$536.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$447.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.00
|
| 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 |
$581.10
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$447.00
|
|
|
PERMANENT PACEMAKER(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
761P1243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$840.20
|
| Rate for Payer: Ambetter Exchange |
$447.00
|
| Rate for Payer: Anthem Medicaid |
$487.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$447.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$447.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$536.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$447.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.00
|
| 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 |
$581.10
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$447.00
|
|
|
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 |
$298.60 |
| 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 |
$106.26
|
| 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 |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.39
|
| Rate for Payer: Molina Healthcare Passport |
$106.26
|
| 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 |
$107.32
|
|
|
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 |
$298.60 |
| 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 |
$106.26
|
| 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 |
$106.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.39
|
| Rate for Payer: Molina Healthcare Passport |
$106.26
|
| 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 |
$107.32
|
|
|
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 |
$127.97 |
| 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 |
$341.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.33
|
| Rate for Payer: PHCS Commercial |
$409.51
|
| Rate for Payer: United Healthcare All Payer |
$375.38
|
|
|
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 |
$127.97 |
| 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 |
$341.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.33
|
| Rate for Payer: PHCS Commercial |
$409.51
|
| Rate for Payer: United Healthcare All Payer |
$375.38
|
|
|
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 |
$1,706.55 |
| Max. Negotiated Rate |
$5,460.96 |
| Rate for Payer: Aetna Commercial |
$4,380.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,437.03
|
| Rate for Payer: Cash Price |
$2,844.25
|
| Rate for Payer: Cigna Commercial |
$4,721.45
|
| Rate for Payer: First Health Commercial |
$5,404.07
|
| Rate for Payer: Humana Commercial |
$4,835.23
|
| 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 |
$4,550.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,948.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.07
|
| Rate for Payer: PHCS Commercial |
$5,460.96
|
| Rate for Payer: United Healthcare All Payer |
$5,005.88
|
|
|
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 |
$1,706.55 |
| Max. Negotiated Rate |
$5,460.96 |
| Rate for Payer: Aetna Commercial |
$4,380.15
|
| 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 |
$4,721.45
|
| Rate for Payer: First Health Commercial |
$5,404.07
|
| Rate for Payer: Humana Commercial |
$4,835.23
|
| 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 |
$4,550.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,948.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.07
|
| 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 |
$3,413.10 |
| Rate for Payer: Ambetter Exchange |
$115.65
|
| Rate for Payer: Anthem Medicaid |
$103.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$115.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.65
|
| 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 |
$150.34
|
| Rate for Payer: UHCCP Medicaid |
$1,990.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.65
|
|
|
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 |
$237.09 |
| Rate for Payer: Ambetter Exchange |
$115.65
|
| Rate for Payer: Anthem Medicaid |
$103.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$115.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.65
|
| 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 |
$150.34
|
| Rate for Payer: UHCCP Medicaid |
$115.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.65
|
|
|
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 |
$1,607.55 |
| Max. Negotiated Rate |
$5,144.16 |
| Rate for Payer: Aetna Commercial |
$4,126.05
|
| 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 |
$5,090.57
|
| Rate for Payer: Humana Commercial |
$4,554.73
|
| 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 |
$4,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,661.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.36
|
| 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 |
$1,607.55 |
| Max. Negotiated Rate |
$5,144.16 |
| Rate for Payer: Aetna Commercial |
$4,126.05
|
| 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 |
$5,090.57
|
| Rate for Payer: Humana Commercial |
$4,554.73
|
| 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 |
$4,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,661.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,697.36
|
| Rate for Payer: PHCS Commercial |
$5,144.16
|
| Rate for Payer: United Healthcare All Payer |
$4,715.48
|
|
|
PERQ CERVICOTHORACIC INJECT
|
Facility
|
OP
|
$11,085.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,997.95 |
| 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 |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,646.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$8,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,643.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,648.65
|
| Rate for Payer: PHCS Commercial |
$10,641.60
|
| Rate for Payer: United Healthcare All Payer |
$9,754.80
|
|
|
PERQ CERVICOTHORACIC INJECT
|
Facility
|
IP
|
$11,085.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
76100421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,325.50 |
| 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 |
$8,868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,643.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,648.65
|
| Rate for Payer: PHCS Commercial |
$10,641.60
|
| Rate for Payer: United Healthcare All Payer |
$9,754.80
|
|
|
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 |
$6,651.00 |
| Rate for Payer: Ambetter Exchange |
$407.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$354.63
|
| Rate for Payer: Anthem Medicaid |
$1,325.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$407.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$407.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$489.50
|
| 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 |
$1,325.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$407.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,351.51
|
| Rate for Payer: Molina Healthcare Passport |
$1,325.01
|
| Rate for Payer: Multiplan PHCS |
$6,651.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$530.30
|
| Rate for Payer: UHCCP Medicaid |
$372.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,338.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$407.92
|
|
|
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 |
$2,190.00 |
| Rate for Payer: Ambetter Exchange |
$407.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$354.63
|
| Rate for Payer: Anthem Medicaid |
$1,325.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$407.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$407.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$489.50
|
| 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 |
$1,325.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$407.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,351.51
|
| Rate for Payer: Molina Healthcare Passport |
$1,325.01
|
| Rate for Payer: Multiplan PHCS |
$2,190.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$530.30
|
| Rate for Payer: UHCCP Medicaid |
$372.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,338.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$407.92
|
|
|
PERQ CERVICOTHORACIC INJECT(T
|
Facility
|
IP
|
$7,435.00
|
|
|
Service Code
|
HCPCS 22510
|
| Hospital Charge Code |
761T0421
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,230.50 |
| 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 |
$5,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,468.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,130.15
|
| 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 |
$2,556.90 |
| 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 |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,799.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$5,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,468.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,130.15
|
| Rate for Payer: PHCS Commercial |
$7,137.60
|
| Rate for Payer: United Healthcare All Payer |
$6,542.80
|
|
|
PERQ DEV BREAST 1ST STRTCTC
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 19283
|
| Hospital Charge Code |
76100294
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.51 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Ambetter Exchange |
$92.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.51
|
| Rate for Payer: Anthem Medicaid |
$208.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.47
|
| Rate for Payer: Cash Price |
$1,159.50
|
| Rate for Payer: Cash Price |
$1,159.50
|
| Rate for Payer: Cigna Commercial |
$436.46
|
| Rate for Payer: Healthspan PPO |
$338.44
|
| Rate for Payer: Humana Medicaid |
$208.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.76
|
| Rate for Payer: Molina Healthcare Passport |
$208.59
|
| Rate for Payer: Multiplan PHCS |
$1,391.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.76
|
| Rate for Payer: UHCCP Medicaid |
$83.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.89
|
|
