|
RHIZOPUS NIGRICANS IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000774
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
RHOPHYLAC 100iu (1,500iu PFS)
|
Facility
|
OP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
25002342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC 100iu (1,500iu PFS)
|
Facility
|
IP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
25002342
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
IP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
OP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
OP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
636T0057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
RHOPHYLAC INJECTION 100IU
|
Professional
|
Both
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
63600057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$524.44 |
| Rate for Payer: Aetna Commercial |
$6.43
|
| Rate for Payer: Ambetter Exchange |
$4.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.96
|
| Rate for Payer: Cash Price |
$437.04
|
| Rate for Payer: Cash Price |
$437.04
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.97
|
| Rate for Payer: Multiplan PHCS |
$524.44
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.46
|
| Rate for Payer: UHCCP Medicaid |
$305.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.97
|
|
|
RHOPHYLAC INJECTION 100IU
|
Facility
|
IP
|
$874.07
|
|
|
Service Code
|
HCPCS J2791
|
| Hospital Charge Code |
636T0057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.22 |
| 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 |
$699.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$760.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.11
|
| Rate for Payer: PHCS Commercial |
$839.11
|
| Rate for Payer: United Healthcare All Payer |
$769.18
|
|
|
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 |
$4,980.90 |
| 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 |
$13,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,444.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,456.07
|
| Rate for Payer: PHCS Commercial |
$15,938.88
|
| Rate for Payer: United Healthcare All Payer |
$14,610.64
|
|
|
R HRT ART/GRFT ANGIO
|
Facility
|
IP
|
$17,043.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
48100068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,112.90 |
| Max. Negotiated Rate |
$16,361.28 |
| Rate for Payer: Aetna Commercial |
$13,123.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,293.54
|
| Rate for Payer: Cash Price |
$8,521.50
|
| Rate for Payer: Cigna Commercial |
$14,145.69
|
| Rate for Payer: First Health Commercial |
$16,190.85
|
| Rate for Payer: Humana Commercial |
$14,486.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,975.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,577.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,112.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,997.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,634.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,827.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,759.67
|
| Rate for Payer: PHCS Commercial |
$16,361.28
|
| Rate for Payer: United Healthcare All Payer |
$14,997.84
|
|
|
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 |
$9,961.80 |
| Rate for Payer: Aetna Commercial |
$1,944.43
|
| Rate for Payer: Ambetter Exchange |
$1,058.86
|
| Rate for Payer: Anthem Medicaid |
$1,082.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,058.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,058.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,270.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,058.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.86
|
| 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 |
$1,376.52
|
| Rate for Payer: UHCCP Medicaid |
$5,811.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,093.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,058.86
|
|
|
R HRT ART/GRFT ANGIO
|
Facility
|
OP
|
$17,043.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
48100068
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$16,361.28 |
| Rate for Payer: Aetna Commercial |
$13,123.11
|
| Rate for Payer: Anthem Medicaid |
$5,861.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,293.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,521.50
|
| Rate for Payer: Cash Price |
$8,521.50
|
| Rate for Payer: Cigna Commercial |
$14,145.69
|
| Rate for Payer: First Health Commercial |
$16,190.85
|
| Rate for Payer: Humana Commercial |
$14,486.55
|
| Rate for Payer: Humana KY Medicaid |
$5,861.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,920.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,975.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,577.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,978.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,997.84
|
| Rate for Payer: Ohio Health Group HMO |
$12,782.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,634.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,827.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,759.67
|
| Rate for Payer: PHCS Commercial |
$16,361.28
|
| Rate for Payer: United Healthcare All Payer |
$14,997.84
|
|
|
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 |
$2,971.90 |
| 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 |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,950.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| 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 |
$2,971.90
|
| 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 |
$3,566.28
|
| 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 |
$13,282.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,444.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,456.07
|
| Rate for Payer: PHCS Commercial |
$15,938.88
|
| Rate for Payer: United Healthcare All Payer |
$14,610.64
|
|
|
R HRT ART/GRFT ANGIO(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761P2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$2,130.12 |
| Rate for Payer: Aetna Commercial |
$1,944.43
|
| Rate for Payer: Ambetter Exchange |
$1,058.86
|
| Rate for Payer: Anthem Medicaid |
$1,082.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,058.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,058.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,270.63
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,058.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,104.31
|
| Rate for Payer: Molina Healthcare Passport |
$1,082.66
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,376.52
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,093.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,058.86
|
|
|
R HRT ART/GRFT ANGIO(T
|
Facility
|
IP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761T2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,800.90 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,800.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,042.07
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT ART/GRFT ANGIO(T
|
Facility
|
OP
|
$16,003.00
|
|
|
Service Code
|
HCPCS 93457
|
| Hospital Charge Code |
761T2481
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$15,362.88 |
| Rate for Payer: Aetna Commercial |
$12,322.31
|
| Rate for Payer: Anthem Medicaid |
$5,503.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,482.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cash Price |
$8,001.50
|
| Rate for Payer: Cigna Commercial |
$13,282.49
|
| Rate for Payer: First Health Commercial |
$15,202.85
|
| Rate for Payer: Humana Commercial |
$13,602.55
|
| Rate for Payer: Humana KY Medicaid |
$5,503.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,559.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,122.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,810.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,613.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,082.64
|
| Rate for Payer: Ohio Health Group HMO |
$12,002.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,042.07
|
| Rate for Payer: PHCS Commercial |
$15,362.88
|
| Rate for Payer: United Healthcare All Payer |
$14,082.64
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Professional
|
Both
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$10,749.60 |
| Rate for Payer: Aetna Commercial |
$1,716.14
|
| Rate for Payer: Ambetter Exchange |
$969.50
|
| Rate for Payer: Anthem Medicaid |
$955.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$969.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$969.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,163.40
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$1,879.99
|
| Rate for Payer: Healthspan PPO |
$1,276.21
|
| Rate for Payer: Humana Medicaid |
$955.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$457.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$969.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.48
|
| Rate for Payer: Molina Healthcare Passport |
$955.37
|
| Rate for Payer: Multiplan PHCS |
$10,749.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.35
|
| Rate for Payer: UHCCP Medicaid |
$6,270.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$964.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$969.50
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
IP
|
$18,495.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
48100067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,548.50 |
| Max. Negotiated Rate |
$17,755.20 |
| Rate for Payer: Aetna Commercial |
$14,241.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,426.10
|
| Rate for Payer: Cash Price |
$9,247.50
|
| Rate for Payer: Cigna Commercial |
$15,350.85
|
| Rate for Payer: First Health Commercial |
$17,570.25
|
| Rate for Payer: Humana Commercial |
$15,720.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,165.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,649.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,548.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,275.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,871.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,090.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,761.55
|
| Rate for Payer: PHCS Commercial |
$17,755.20
|
| Rate for Payer: United Healthcare All Payer |
$16,275.60
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
OP
|
$18,495.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
48100067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$17,755.20 |
| Rate for Payer: Aetna Commercial |
$14,241.15
|
| Rate for Payer: Anthem Medicaid |
$6,360.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,426.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$9,247.50
|
| Rate for Payer: Cash Price |
$9,247.50
|
| Rate for Payer: Cigna Commercial |
$15,350.85
|
| Rate for Payer: First Health Commercial |
$17,570.25
|
| Rate for Payer: Humana Commercial |
$15,720.75
|
| Rate for Payer: Humana KY Medicaid |
$6,360.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,425.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,165.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,649.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,488.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,275.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,871.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,796.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,090.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,761.55
|
| Rate for Payer: PHCS Commercial |
$17,755.20
|
| Rate for Payer: United Healthcare All Payer |
$16,275.60
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
IP
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,374.80 |
| Max. Negotiated Rate |
$17,199.36 |
| Rate for Payer: Aetna Commercial |
$13,795.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,974.48
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$14,870.28
|
| Rate for Payer: First Health Commercial |
$17,020.20
|
| Rate for Payer: Humana Commercial |
$15,228.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,691.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,222.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,374.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,766.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,437.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,586.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,362.04
|
| Rate for Payer: PHCS Commercial |
$17,199.36
|
| Rate for Payer: United Healthcare All Payer |
$15,766.08
|
|
|
R HRT CORONARY ARTERY ANGIO
|
Facility
|
OP
|
$17,916.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
76102480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$17,199.36 |
| Rate for Payer: Aetna Commercial |
$13,795.32
|
| Rate for Payer: Anthem Medicaid |
$6,161.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,974.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cash Price |
$8,958.00
|
| Rate for Payer: Cigna Commercial |
$14,870.28
|
| Rate for Payer: First Health Commercial |
$17,020.20
|
| Rate for Payer: Humana Commercial |
$15,228.60
|
| Rate for Payer: Humana KY Medicaid |
$6,161.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,224.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,691.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,222.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,284.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,766.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,437.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,586.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,362.04
|
| Rate for Payer: PHCS Commercial |
$17,199.36
|
| Rate for Payer: United Healthcare All Payer |
$15,766.08
|
|
|
R HRT CORONARY ARTERY ANGIO(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761P2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$1,879.99 |
| Rate for Payer: Aetna Commercial |
$1,716.14
|
| Rate for Payer: Ambetter Exchange |
$969.50
|
| Rate for Payer: Anthem Medicaid |
$955.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$969.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$969.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,163.40
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$1,879.99
|
| Rate for Payer: Healthspan PPO |
$1,276.21
|
| Rate for Payer: Humana Medicaid |
$955.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$457.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$969.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$974.48
|
| Rate for Payer: Molina Healthcare Passport |
$955.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.35
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$964.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$969.50
|
|
|
R HRT CORONARY ARTERY ANGIO(T
|
Facility
|
IP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761T2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,209.80 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,209.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,108.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,982.54
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
R HRT CORONARY ARTERY ANGIO(T
|
Facility
|
OP
|
$17,366.00
|
|
|
Service Code
|
HCPCS 93456
|
| Hospital Charge Code |
761T2480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$16,671.36 |
| Rate for Payer: Aetna Commercial |
$13,371.82
|
| Rate for Payer: Anthem Medicaid |
$5,972.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,545.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cash Price |
$8,683.00
|
| Rate for Payer: Cigna Commercial |
$14,413.78
|
| Rate for Payer: First Health Commercial |
$16,497.70
|
| Rate for Payer: Humana Commercial |
$14,761.10
|
| Rate for Payer: Humana KY Medicaid |
$5,972.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,032.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,240.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,816.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,091.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,282.08
|
| Rate for Payer: Ohio Health Group HMO |
$13,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,108.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,982.54
|
| Rate for Payer: PHCS Commercial |
$16,671.36
|
| Rate for Payer: United Healthcare All Payer |
$15,282.08
|
|
|
RHYTIDECTOMY; FOREHEAD
|
Professional
|
Both
|
$6,257.00
|
|
|
Service Code
|
HCPCS 15824
|
| Hospital Charge Code |
76100217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,379.90 |
| Rate for Payer: Aetna Commercial |
$1,570.95
|
| Rate for Payer: Anthem Medicaid |
$504.16
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$1,478.41
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$504.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$949.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.24
|
| Rate for Payer: Molina Healthcare Passport |
$504.16
|
| Rate for Payer: Multiplan PHCS |
$3,754.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,379.90
|
| Rate for Payer: UHCCP Medicaid |
$2,189.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.20
|
|
