|
RHINOPLASTY
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,780.91 |
| Rate for Payer: Aetna Commercial |
$1,676.92
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,780.91
|
| Rate for Payer: Healthspan PPO |
$1,414.18
|
| Rate for Payer: Humana Medicaid |
$629.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.62
|
| Rate for Payer: Molina Healthcare Passport |
$629.04
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.33
|
|
|
RHINOPLASTY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
76101129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| 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 |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RHINOPLASTY
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
76101130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
RHINOPLASTY(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30430
|
| Hospital Charge Code |
761P1129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.86 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,258.84
|
| Rate for Payer: Anthem Medicaid |
$376.86
|
| 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 |
$1,340.27
|
| Rate for Payer: Healthspan PPO |
$1,061.60
|
| Rate for Payer: Humana Medicaid |
$376.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.40
|
| Rate for Payer: Molina Healthcare Passport |
$376.86
|
| 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 |
$380.63
|
|
|
RHINOPLASTY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 30435
|
| Hospital Charge Code |
761P1130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,780.91 |
| Rate for Payer: Aetna Commercial |
$1,676.92
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,780.91
|
| Rate for Payer: Healthspan PPO |
$1,414.18
|
| Rate for Payer: Humana Medicaid |
$629.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,517.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$641.62
|
| Rate for Payer: Molina Healthcare Passport |
$629.04
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$635.33
|
|
|
RHINOPLASTY - PRIMARY
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.73 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,946.53
|
| Rate for Payer: Anthem Medicaid |
$982.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,961.50
|
| Rate for Payer: Healthspan PPO |
$1,641.55
|
| Rate for Payer: Humana Medicaid |
$982.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,002.38
|
| Rate for Payer: Molina Healthcare Passport |
$982.73
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$992.56
|
|
|
RHINOPLASTY - PRIMARY
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
RHINOPLASTY - PRIMARY
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
76101128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
RHINOPLASTY PRIMARY
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RHINOPLASTY PRIMARY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
RHINOPLASTY PRIMARY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
76101127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,451.25
|
| Rate for Payer: Anthem Medicaid |
$571.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,489.89
|
| Rate for Payer: Healthspan PPO |
$1,223.87
|
| Rate for Payer: Humana Medicaid |
$571.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,288.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.02
|
| Rate for Payer: Molina Healthcare Passport |
$571.59
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.31
|
|
|
RHINOPLASTY - PRIMARY(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 30420
|
| Hospital Charge Code |
761P1128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.73 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,946.53
|
| Rate for Payer: Anthem Medicaid |
$982.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,961.50
|
| Rate for Payer: Healthspan PPO |
$1,641.55
|
| Rate for Payer: Humana Medicaid |
$982.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,744.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,002.38
|
| Rate for Payer: Molina Healthcare Passport |
$982.73
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$992.56
|
|
|
RHINOPLASTY PRIMARY(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 30400
|
| Hospital Charge Code |
761P1127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,451.25
|
| Rate for Payer: Anthem Medicaid |
$571.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,489.89
|
| Rate for Payer: Healthspan PPO |
$1,223.87
|
| Rate for Payer: Humana Medicaid |
$571.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,288.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.02
|
| Rate for Payer: Molina Healthcare Passport |
$571.59
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.31
|
|
|
RHIZOPUS NIGRICANS IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
RHIZOPUS NIGRICANS IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
RHOPHYLAC 100iu (1,500iu PFS)
|
Facility
|
IP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
25002342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.63 |
| Max. Negotiated Rate |
$839.11 |
| Rate for Payer: Aetna Commercial |
$673.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.77
|
| Rate for Payer: Cash Price |
$437.04
|
| Rate for Payer: Cigna Commercial |
$725.48
|
| Rate for Payer: First Health Commercial |
$830.37
|
| Rate for Payer: Humana Commercial |
$742.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.18
|
| Rate for Payer: Ohio Health Group HMO |
$655.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.96
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC 100iu (1,500iu PFS)
|
Facility
|
OP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
25002342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.63 |
| Max. Negotiated Rate |
$839.11 |
| Rate for Payer: Aetna Commercial |
$673.03
|
| Rate for Payer: Anthem Medicaid |
$300.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.77
|
| Rate for Payer: Cash Price |
$437.04
|
| Rate for Payer: Cigna Commercial |
$725.48
|
| Rate for Payer: First Health Commercial |
$830.37
|
| Rate for Payer: Humana Commercial |
$742.96
|
| Rate for Payer: Humana KY Medicaid |
$300.59
|
| Rate for Payer: Kentucky WC Medicaid |
$303.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.18
|
| Rate for Payer: Ohio Health Group HMO |
$655.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.96
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
IP
|
$56.13
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
636T0057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.78
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cigna Commercial |
$46.59
|
| Rate for Payer: First Health Commercial |
$53.32
|
| Rate for Payer: Humana Commercial |
$47.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.39
|
| Rate for Payer: Ohio Health Group HMO |
$42.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.40
|
| Rate for Payer: PHCS Commercial |
$53.88
|
| Rate for Payer: United Healthcare All Payer |
$49.39
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
OP
|
$56.13
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
636T0057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Anthem Medicaid |
$19.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.78
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cigna Commercial |
$46.59
|
| Rate for Payer: First Health Commercial |
$53.32
|
| Rate for Payer: Humana Commercial |
$47.71
|
| Rate for Payer: Humana KY Medicaid |
$19.30
|
| Rate for Payer: Kentucky WC Medicaid |
$19.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.39
|
| Rate for Payer: Ohio Health Group HMO |
$42.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.40
|
| Rate for Payer: PHCS Commercial |
$53.88
|
| Rate for Payer: United Healthcare All Payer |
$49.39
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
IP
|
$56.13
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.78
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cigna Commercial |
$46.59
|
| Rate for Payer: First Health Commercial |
$53.32
|
| Rate for Payer: Humana Commercial |
$47.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.39
|
| Rate for Payer: Ohio Health Group HMO |
$42.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.40
|
| Rate for Payer: PHCS Commercial |
$53.88
|
| Rate for Payer: United Healthcare All Payer |
$49.39
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
OP
|
$56.13
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$43.22
|
| Rate for Payer: Anthem Medicaid |
$19.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$43.78
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cigna Commercial |
$46.59
|
| Rate for Payer: First Health Commercial |
$53.32
|
| Rate for Payer: Humana Commercial |
$47.71
|
| Rate for Payer: Humana KY Medicaid |
$19.30
|
| Rate for Payer: Kentucky WC Medicaid |
$19.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$41.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$49.39
|
| Rate for Payer: Ohio Health Group HMO |
$42.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.40
|
| Rate for Payer: PHCS Commercial |
$53.88
|
| Rate for Payer: United Healthcare All Payer |
$49.39
|
|
|
RHOPHYLAC INJECTION 100IU
|
Professional
|
Both
|
$56.13
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$56.13 |
| Rate for Payer: Aetna Commercial |
$6.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$56.13
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Cash Price |
$28.07
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.74
|
| Rate for Payer: Multiplan PHCS |
$33.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.29
|
| Rate for Payer: UHCCP Medicaid |
$19.65
|
|
|
R HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$16,603.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
76102481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,158.39 |
| Max. Negotiated Rate |
$15,938.88 |
| Rate for Payer: Aetna Commercial |
$12,784.31
|
| Rate for Payer: Anthem Medicaid |
$5,709.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,950.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,301.50
|
| Rate for Payer: Cash Price |
$8,301.50
|
| Rate for Payer: Cigna Commercial |
$13,780.49
|
| Rate for Payer: First Health Commercial |
$15,772.85
|
| Rate for Payer: Humana Commercial |
$14,112.55
|
| Rate for Payer: Humana KY Medicaid |
$5,709.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,767.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,614.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,253.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,824.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,610.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,320.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,158.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,146.93
|
| Rate for Payer: PHCS Commercial |
$15,938.88
|
| Rate for Payer: United Healthcare All Payer |
$14,610.64
|
|
|
R HRT ART/GRFT ANGIO
|
Professional
|
Both
|
$16,603.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
76102481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.70 |
| Max. Negotiated Rate |
$16,603.00 |
| Rate for Payer: Aetna Commercial |
$1,944.43
|
| Rate for Payer: Anthem Medicaid |
$1,082.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$16,603.00
|
| Rate for Payer: Cash Price |
$8,301.50
|
| Rate for Payer: Cash Price |
$8,301.50
|
| Rate for Payer: Cigna Commercial |
$2,130.12
|
| Rate for Payer: Healthspan PPO |
$1,445.13
|
| Rate for Payer: Humana Medicaid |
$1,082.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$512.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,104.31
|
| Rate for Payer: Molina Healthcare Passport |
$1,082.66
|
| Rate for Payer: Multiplan PHCS |
$9,961.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,622.10
|
| Rate for Payer: UHCCP Medicaid |
$5,811.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,093.49
|
|
|
R HRT ART/GRFT ANGIO
|
Facility
|
IP
|
$16,603.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
76102481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,158.39 |
| Max. Negotiated Rate |
$15,938.88 |
| Rate for Payer: Aetna Commercial |
$12,784.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,950.34
|
| Rate for Payer: Cash Price |
$8,301.50
|
| Rate for Payer: Cigna Commercial |
$13,780.49
|
| Rate for Payer: First Health Commercial |
$15,772.85
|
| Rate for Payer: Humana Commercial |
$14,112.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,614.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,253.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,980.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,610.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,452.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,320.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,158.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,146.93
|
| Rate for Payer: PHCS Commercial |
$15,938.88
|
| Rate for Payer: United Healthcare All Payer |
$14,610.64
|
|
