|
RIV3 VACCINE NO PRESERV IM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
77000027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Ambetter Exchange |
$83.49
|
| Rate for Payer: Anthem Medicaid |
$83.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.19
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$83.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$85.16
|
| Rate for Payer: Molina Healthcare Passport |
$83.49
|
| Rate for Payer: Multiplan PHCS |
$70.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.54
|
| Rate for Payer: UHCCP Medicaid |
$41.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.49
|
|
|
RIV3 VACCINE NO PRESERV IM(T
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
770T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem Medicaid |
$40.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Humana KY Medicaid |
$40.58
|
| Rate for Payer: Kentucky WC Medicaid |
$40.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
RIV3 VACCINE NO PRESERV IM(T
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 90673
|
| Hospital Charge Code |
770T0027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$113.28 |
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.04
|
| Rate for Payer: Cash Price |
$59.00
|
| Rate for Payer: Cigna Commercial |
$97.94
|
| Rate for Payer: First Health Commercial |
$112.10
|
| Rate for Payer: Humana Commercial |
$100.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.84
|
| Rate for Payer: Ohio Health Group HMO |
$88.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.42
|
| Rate for Payer: PHCS Commercial |
$113.28
|
| Rate for Payer: United Healthcare All Payer |
$103.84
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: Anthem Medicaid |
$73.40
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Humana Medicaid |
$73.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.87
|
| Rate for Payer: Molina Healthcare Passport |
$73.40
|
| Rate for Payer: Multiplan PHCS |
$78.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.70
|
| Rate for Payer: UHCCP Medicaid |
$45.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.13
|
|
|
RIV4 VACC RECOMBINANT DNA IM
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
77000031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA I(T
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
770T0031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem Medicaid |
$45.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Humana KY Medicaid |
$45.05
|
| Rate for Payer: Kentucky WC Medicaid |
$45.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIV4 VACC RECOMBINANT DNA I(T
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90682
|
| Hospital Charge Code |
770T0031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.30 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.39
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
RIVACOR 7 VR-T DF4 PRO MRI
|
Facility
|
IP
|
$36,837.50
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,051.25 |
| Max. Negotiated Rate |
$35,364.00 |
| Rate for Payer: Aetna Commercial |
$28,364.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,733.25
|
| Rate for Payer: Cash Price |
$18,418.75
|
| Rate for Payer: Cigna Commercial |
$30,575.12
|
| Rate for Payer: First Health Commercial |
$34,995.62
|
| Rate for Payer: Humana Commercial |
$31,311.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,206.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,186.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,051.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,417.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,048.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,417.88
|
| Rate for Payer: PHCS Commercial |
$35,364.00
|
| Rate for Payer: United Healthcare All Payer |
$32,417.00
|
|
|
RIVACOR 7 VR-T DF4 PRO MRI
|
Facility
|
OP
|
$36,837.50
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,051.25 |
| Max. Negotiated Rate |
$35,364.00 |
| Rate for Payer: Aetna Commercial |
$28,364.88
|
| Rate for Payer: Anthem Medicaid |
$12,668.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,733.25
|
| Rate for Payer: Cash Price |
$18,418.75
|
| Rate for Payer: Cigna Commercial |
$30,575.12
|
| Rate for Payer: First Health Commercial |
$34,995.62
|
| Rate for Payer: Humana Commercial |
$31,311.88
|
| Rate for Payer: Humana KY Medicaid |
$12,668.42
|
| Rate for Payer: Kentucky WC Medicaid |
$12,797.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,206.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,186.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,051.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,922.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,417.00
|
| Rate for Payer: Ohio Health Group HMO |
$27,628.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,048.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,417.88
|
| Rate for Payer: PHCS Commercial |
$35,364.00
|
| Rate for Payer: United Healthcare All Payer |
$32,417.00
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(P
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761P2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$2,455.40 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: Ambetter Exchange |
$1,184.65
|
| Rate for Payer: Anthem Medicaid |
$1,247.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,184.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,184.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,421.58
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$2,455.40
|
| Rate for Payer: Healthspan PPO |
$1,666.22
|
| Rate for Payer: Humana Medicaid |
$1,247.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,184.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,272.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,247.62
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.05
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,260.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,184.65
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(T
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761T2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,579.40 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,579.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,180.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,832.62
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(T
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761T2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem Medicaid |
$6,395.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| 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 |
$9,299.00
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Humana KY Medicaid |
$6,395.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,524.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,180.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,832.62
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Professional
|
Both
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.99 |
| Max. Negotiated Rate |
$11,554.80 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: Ambetter Exchange |
$1,184.65
|
| Rate for Payer: Anthem Medicaid |
$1,247.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,184.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,184.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,421.58
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$2,455.40
|
| Rate for Payer: Healthspan PPO |
$1,666.22
|
| Rate for Payer: Humana Medicaid |
$1,247.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,184.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,272.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,247.62
|
| Rate for Payer: Multiplan PHCS |
$11,554.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.05
|
| Rate for Payer: UHCCP Medicaid |
$6,740.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,260.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,184.65
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
OP
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$18,487.68 |
| Rate for Payer: Aetna Commercial |
$14,828.66
|
| Rate for Payer: Anthem Medicaid |
$6,622.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,021.24
|
| 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 |
$9,629.00
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$15,984.14
|
| Rate for Payer: First Health Commercial |
$18,295.10
|
| Rate for Payer: Humana Commercial |
$16,369.30
|
| Rate for Payer: Humana KY Medicaid |
$6,622.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,690.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,791.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,212.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,755.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,947.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,443.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,754.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,288.02
|
| Rate for Payer: PHCS Commercial |
$18,487.68
|
| Rate for Payer: United Healthcare All Payer |
$16,947.04
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
IP
|
$19,807.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
48100072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,942.10 |
| Max. Negotiated Rate |
$19,014.72 |
| Rate for Payer: Aetna Commercial |
$15,251.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,449.46
|
| Rate for Payer: Cash Price |
$9,903.50
|
| Rate for Payer: Cigna Commercial |
$16,439.81
|
| Rate for Payer: First Health Commercial |
$18,816.65
|
| Rate for Payer: Humana Commercial |
$16,835.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,241.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,617.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,942.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$14,855.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,232.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,666.83
|
| Rate for Payer: PHCS Commercial |
$19,014.72
|
| Rate for Payer: United Healthcare All Payer |
$17,430.16
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
OP
|
$19,807.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
48100072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$19,014.72 |
| Rate for Payer: Aetna Commercial |
$15,251.39
|
| Rate for Payer: Anthem Medicaid |
$6,811.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,449.46
|
| 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 |
$9,903.50
|
| Rate for Payer: Cash Price |
$9,903.50
|
| Rate for Payer: Cigna Commercial |
$16,439.81
|
| Rate for Payer: First Health Commercial |
$18,816.65
|
| Rate for Payer: Humana Commercial |
$16,835.95
|
| Rate for Payer: Humana KY Medicaid |
$6,811.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,880.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,241.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,617.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,948.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,430.16
|
| Rate for Payer: Ohio Health Group HMO |
$14,855.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,232.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,666.83
|
| Rate for Payer: PHCS Commercial |
$19,014.72
|
| Rate for Payer: United Healthcare All Payer |
$17,430.16
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
IP
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,777.40 |
| Max. Negotiated Rate |
$18,487.68 |
| Rate for Payer: Aetna Commercial |
$14,828.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,021.24
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$15,984.14
|
| Rate for Payer: First Health Commercial |
$18,295.10
|
| Rate for Payer: Humana Commercial |
$16,369.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,791.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,212.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,777.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,947.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,443.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,754.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,288.02
|
| Rate for Payer: PHCS Commercial |
$18,487.68
|
| Rate for Payer: United Healthcare All Payer |
$16,947.04
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Professional
|
Both
|
$16,365.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$9,819.00 |
| Rate for Payer: Aetna Commercial |
$1,957.71
|
| Rate for Payer: Ambetter Exchange |
$1,073.80
|
| Rate for Payer: Anthem Medicaid |
$1,088.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,073.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,073.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,288.56
|
| Rate for Payer: Cash Price |
$8,182.50
|
| Rate for Payer: Cash Price |
$8,182.50
|
| Rate for Payer: Cigna Commercial |
$2,144.22
|
| Rate for Payer: Healthspan PPO |
$1,454.99
|
| Rate for Payer: Humana Medicaid |
$1,088.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,073.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.89
|
| Rate for Payer: Multiplan PHCS |
$9,819.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,395.94
|
| Rate for Payer: UHCCP Medicaid |
$5,727.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,073.80
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
IP
|
$16,365.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,909.50 |
| Max. Negotiated Rate |
$15,710.40 |
| Rate for Payer: Aetna Commercial |
$12,601.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,764.70
|
| Rate for Payer: Cash Price |
$8,182.50
|
| Rate for Payer: Cigna Commercial |
$13,582.95
|
| Rate for Payer: First Health Commercial |
$15,546.75
|
| Rate for Payer: Humana Commercial |
$13,910.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,419.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,077.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,909.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,401.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,237.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,291.85
|
| Rate for Payer: PHCS Commercial |
$15,710.40
|
| Rate for Payer: United Healthcare All Payer |
$14,401.20
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
OP
|
$21,860.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
48100071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$20,985.60 |
| Rate for Payer: Aetna Commercial |
$16,832.20
|
| Rate for Payer: Anthem Medicaid |
$7,517.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,050.80
|
| 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 |
$10,930.00
|
| Rate for Payer: Cash Price |
$10,930.00
|
| Rate for Payer: Cigna Commercial |
$18,143.80
|
| Rate for Payer: First Health Commercial |
$20,767.00
|
| Rate for Payer: Humana Commercial |
$18,581.00
|
| Rate for Payer: Humana KY Medicaid |
$7,517.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,594.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,925.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,132.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,668.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,236.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,018.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,083.40
|
| Rate for Payer: PHCS Commercial |
$20,985.60
|
| Rate for Payer: United Healthcare All Payer |
$19,236.80
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
IP
|
$21,860.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
48100071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,558.00 |
| Max. Negotiated Rate |
$20,985.60 |
| Rate for Payer: Aetna Commercial |
$16,832.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,050.80
|
| Rate for Payer: Cash Price |
$10,930.00
|
| Rate for Payer: Cigna Commercial |
$18,143.80
|
| Rate for Payer: First Health Commercial |
$20,767.00
|
| Rate for Payer: Humana Commercial |
$18,581.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,925.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,132.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,558.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,236.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,395.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,018.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,083.40
|
| Rate for Payer: PHCS Commercial |
$20,985.60
|
| Rate for Payer: United Healthcare All Payer |
$19,236.80
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
OP
|
$16,365.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$15,710.40 |
| Rate for Payer: Aetna Commercial |
$12,601.05
|
| Rate for Payer: Anthem Medicaid |
$5,627.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,764.70
|
| 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 |
$8,182.50
|
| Rate for Payer: Cash Price |
$8,182.50
|
| Rate for Payer: Cigna Commercial |
$13,582.95
|
| Rate for Payer: First Health Commercial |
$15,546.75
|
| Rate for Payer: Humana Commercial |
$13,910.25
|
| Rate for Payer: Humana KY Medicaid |
$5,627.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,685.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,419.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,077.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,740.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,401.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,092.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,237.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,291.85
|
| Rate for Payer: PHCS Commercial |
$15,710.40
|
| Rate for Payer: United Healthcare All Payer |
$14,401.20
|
|
|
R/L HC W/INJ ART& L VENT IMG(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761P2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$2,144.22 |
| Rate for Payer: Aetna Commercial |
$1,957.71
|
| Rate for Payer: Ambetter Exchange |
$1,073.80
|
| Rate for Payer: Anthem Medicaid |
$1,088.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,073.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,073.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,288.56
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$2,144.22
|
| Rate for Payer: Healthspan PPO |
$1,454.99
|
| Rate for Payer: Humana Medicaid |
$1,088.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,073.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.89
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,395.94
|
| Rate for Payer: UHCCP Medicaid |
$213.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,073.80
|
|
|
R/L HC W/INJ ART& L VENT IMG(T
|
Facility
|
IP
|
$15,755.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761T2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,726.50 |
| Max. Negotiated Rate |
$15,124.80 |
| Rate for Payer: Aetna Commercial |
$12,131.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,288.90
|
| Rate for Payer: Cash Price |
$7,877.50
|
| Rate for Payer: Cigna Commercial |
$13,076.65
|
| Rate for Payer: First Health Commercial |
$14,967.25
|
| Rate for Payer: Humana Commercial |
$13,391.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,919.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,627.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,726.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,864.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,816.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,706.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,870.95
|
| Rate for Payer: PHCS Commercial |
$15,124.80
|
| Rate for Payer: United Healthcare All Payer |
$13,864.40
|
|
