|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761P1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$92.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.38
|
| Rate for Payer: Anthem Medicaid |
$43.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Healthspan PPO |
$178.94
|
| Rate for Payer: Humana Medicaid |
$43.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.05
|
| Rate for Payer: Molina Healthcare Passport |
$43.19
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$44.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.62
|
|
|
BONE MARROW ASP W/ BX(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761T1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761T1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
45000244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761T1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761T1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
45000244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.41 |
| Max. Negotiated Rate |
$2,166.72 |
| Rate for Payer: Aetna Commercial |
$1,737.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,760.46
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$1,873.31
|
| Rate for Payer: First Health Commercial |
$2,144.15
|
| Rate for Payer: Humana Commercial |
$1,918.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,850.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,665.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$677.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,986.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.67
|
| Rate for Payer: PHCS Commercial |
$2,166.72
|
| Rate for Payer: United Healthcare All Payer |
$1,986.16
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.41 |
| Max. Negotiated Rate |
$2,166.72 |
| Rate for Payer: Aetna Commercial |
$1,737.89
|
| Rate for Payer: Anthem Medicaid |
$776.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,760.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$1,873.31
|
| Rate for Payer: First Health Commercial |
$2,144.15
|
| Rate for Payer: Humana Commercial |
$1,918.45
|
| Rate for Payer: Humana KY Medicaid |
$776.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$784.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,850.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,665.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$791.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,986.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.67
|
| Rate for Payer: PHCS Commercial |
$2,166.72
|
| Rate for Payer: United Healthcare All Payer |
$1,986.16
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761P1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna Commercial |
$117.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.82
|
| Rate for Payer: Anthem Medicaid |
$54.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$291.00
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$111.33
|
| Rate for Payer: Healthspan PPO |
$199.46
|
| Rate for Payer: Humana Medicaid |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.98
|
| Rate for Payer: Molina Healthcare Passport |
$54.88
|
| Rate for Payer: Multiplan PHCS |
$174.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.70
|
| Rate for Payer: UHCCP Medicaid |
$37.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.43
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$2,257.00 |
| Rate for Payer: Aetna Commercial |
$117.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.82
|
| Rate for Payer: Anthem Medicaid |
$54.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,257.00
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$111.33
|
| Rate for Payer: Healthspan PPO |
$199.46
|
| Rate for Payer: Humana Medicaid |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.98
|
| Rate for Payer: Molina Healthcare Passport |
$54.88
|
| Rate for Payer: Multiplan PHCS |
$1,354.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,579.90
|
| Rate for Payer: UHCCP Medicaid |
$37.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.43
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Facility
|
OP
|
$3,764.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.32 |
| Max. Negotiated Rate |
$3,613.44 |
| Rate for Payer: Aetna Commercial |
$2,898.28
|
| Rate for Payer: Anthem Medicaid |
$1,294.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,935.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,882.00
|
| Rate for Payer: Cash Price |
$1,882.00
|
| Rate for Payer: Cigna Commercial |
$3,124.12
|
| Rate for Payer: First Health Commercial |
$3,575.80
|
| Rate for Payer: Humana Commercial |
$3,199.40
|
| Rate for Payer: Humana KY Medicaid |
$1,294.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,307.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,320.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.84
|
| Rate for Payer: PHCS Commercial |
$3,613.44
|
| Rate for Payer: United Healthcare All Payer |
$3,312.32
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Facility
|
IP
|
$3,764.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.32 |
| Max. Negotiated Rate |
$3,613.44 |
| Rate for Payer: Aetna Commercial |
$2,898.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,935.92
|
| Rate for Payer: Cash Price |
$1,882.00
|
| Rate for Payer: Cigna Commercial |
$3,124.12
|
| Rate for Payer: First Health Commercial |
$3,575.80
|
| Rate for Payer: Humana Commercial |
$3,199.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.84
|
| Rate for Payer: PHCS Commercial |
$3,613.44
|
| Rate for Payer: United Healthcare All Payer |
$3,312.32
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Professional
|
Both
|
$3,764.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$3,764.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.44
|
| Rate for Payer: Anthem Medicaid |
$62.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,764.00
|
| Rate for Payer: Cash Price |
$1,882.00
|
| Rate for Payer: Cash Price |
$1,882.00
|
| Rate for Payer: Cigna Commercial |
$271.92
|
| Rate for Payer: Humana Medicaid |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.57
|
| Rate for Payer: Molina Healthcare Passport |
$62.32
|
| Rate for Payer: Multiplan PHCS |
$2,258.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,634.80
|
| Rate for Payer: UHCCP Medicaid |
$65.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.94
|
|
|
BONE MARROW BIOPSY & ASPIRAT(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761P1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$271.92 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.44
|
| Rate for Payer: Anthem Medicaid |
$62.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$271.92
|
| Rate for Payer: Humana Medicaid |
$62.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.57
|
| Rate for Payer: Molina Healthcare Passport |
$62.32
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$65.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.94
|
|
|
BONE MARROW BIOPSY & ASPIRAT(T
|
Facility
|
OP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761T1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$3,440.64 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem Medicaid |
$1,232.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Humana KY Medicaid |
$1,232.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,245.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,257.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,111.04
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
BONE MARROW BIOPSY & ASPIRAT(T
|
Facility
|
IP
|
$3,584.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761T1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$3,440.64 |
| Rate for Payer: Aetna Commercial |
$2,759.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,795.52
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cigna Commercial |
$2,974.72
|
| Rate for Payer: First Health Commercial |
$3,404.80
|
| Rate for Payer: Humana Commercial |
$3,046.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,938.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,644.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,153.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,688.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,111.04
|
| Rate for Payer: PHCS Commercial |
$3,440.64
|
| Rate for Payer: United Healthcare All Payer |
$3,153.92
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Anthem Medicaid |
$147.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$313.90
|
| Rate for Payer: Healthspan PPO |
$173.39
|
| Rate for Payer: Humana Medicaid |
$147.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.49
|
| Rate for Payer: Molina Healthcare Passport |
$147.54
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.02
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$5,602.69 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$77.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,001.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5,602.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,402.59
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$77.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,001.92
|
| Rate for Payer: Kentucky WC Medicaid |
$78.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,802.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS
|
Facility
|
OP
|
$5,602.69
|
|
|
Service Code
|
CPT 38232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,001.92 |
| Max. Negotiated Rate |
$5,602.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,001.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5,602.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,402.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,001.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,802.30
|
|
|
BONE MINERAL DENSITY TESTING
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
BONE MINERAL DENSITY TESTING
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Anthem Medicaid |
$76.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$163.64
|
| Rate for Payer: Healthspan PPO |
$103.56
|
| Rate for Payer: Humana Medicaid |
$76.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.57
|
| Rate for Payer: Molina Healthcare Passport |
$76.05
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.81
|
|
|
BONE MINERAL DENSITY TESTING
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
