|
BONE MINERAL DENSITY TESTING(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320P0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$163.64 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Anthem Medicaid |
$76.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| 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 |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.81
|
|
|
BONE MINERAL DENSITY TESTING(T
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320T0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BONE MINERAL DENSITY TESTING(T
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320T0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.20
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
BONE MINERAL VERTEBRAL FX
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
BONE MINERAL VERTEBRAL FX
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
BONE MINERAL VERTEBRAL FX
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Anthem Medicaid |
$41.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$744.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$88.09
|
| Rate for Payer: Humana Medicaid |
$41.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.81
|
| Rate for Payer: Molina Healthcare Passport |
$41.97
|
| Rate for Payer: Multiplan PHCS |
$446.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$520.80
|
| Rate for Payer: UHCCP Medicaid |
$260.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.39
|
|
|
BONE MINERAL VERTEBRAL FX(P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320P0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$88.09 |
| Rate for Payer: Anthem Medicaid |
$41.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$88.09
|
| Rate for Payer: Humana Medicaid |
$41.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.81
|
| Rate for Payer: Molina Healthcare Passport |
$41.97
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.39
|
|
|
BONE MINERAL VERTEBRAL FX(T
|
Facility
|
IP
|
$699.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320T0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.87 |
| Max. Negotiated Rate |
$671.04 |
| Rate for Payer: Aetna Commercial |
$538.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.22
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$580.17
|
| Rate for Payer: First Health Commercial |
$664.05
|
| Rate for Payer: Humana Commercial |
$594.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.12
|
| Rate for Payer: Ohio Health Group HMO |
$524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.69
|
| Rate for Payer: PHCS Commercial |
$671.04
|
| Rate for Payer: United Healthcare All Payer |
$615.12
|
|
|
BONE MINERAL VERTEBRAL FX(T
|
Facility
|
OP
|
$699.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320T0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.87 |
| Max. Negotiated Rate |
$671.04 |
| Rate for Payer: Aetna Commercial |
$538.23
|
| Rate for Payer: Anthem Medicaid |
$240.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cash Price |
$349.50
|
| Rate for Payer: Cigna Commercial |
$580.17
|
| Rate for Payer: First Health Commercial |
$664.05
|
| Rate for Payer: Humana Commercial |
$594.15
|
| Rate for Payer: Humana KY Medicaid |
$240.39
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$242.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$515.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.12
|
| Rate for Payer: Ohio Health Group HMO |
$524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.69
|
| Rate for Payer: PHCS Commercial |
$671.04
|
| Rate for Payer: United Healthcare All Payer |
$615.12
|
|
|
BONE VIBRATOR HEARING AID
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
47000045
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
BONE VIBRATOR HEARING AID
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
47000045
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
BONIVA 1MG (3MG/3ML KIT) SYR
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
25002158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
BONIVA 1MG (3MG/3ML KIT) SYR
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
25002158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.49 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Anthem Medicaid |
$231.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Humana KY Medicaid |
$231.44
|
| Rate for Payer: Kentucky WC Medicaid |
$233.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.63
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
| Rate for Payer: Aetna Commercial |
$518.21
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$3,520.70
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$3,379.87 |
| Rate for Payer: Aetna Commercial |
$2,710.94
|
| Rate for Payer: Anthem Medicaid |
$1,210.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cigna Commercial |
$2,922.18
|
| Rate for Payer: First Health Commercial |
$3,344.66
|
| Rate for Payer: Humana Commercial |
$2,992.60
|
| Rate for Payer: Humana KY Medicaid |
$1,210.77
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.42
|
| Rate for Payer: PHCS Commercial |
$3,379.87
|
| Rate for Payer: United Healthcare All Payer |
$3,098.22
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Professional
|
Both
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$12.68 |
| Rate for Payer: Aetna Commercial |
$8.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.68
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Healthspan PPO |
$7.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.59
|
| Rate for Payer: Multiplan PHCS |
$7.61
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.88
|
| Rate for Payer: UHCCP Medicaid |
$4.44
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$3,520.70
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$457.69 |
| Max. Negotiated Rate |
$3,379.87 |
| Rate for Payer: Aetna Commercial |
$2,710.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.15
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cigna Commercial |
$2,922.18
|
| Rate for Payer: First Health Commercial |
$3,344.66
|
| Rate for Payer: Humana Commercial |
$2,992.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.42
|
| Rate for Payer: PHCS Commercial |
$3,379.87
|
| Rate for Payer: United Healthcare All Payer |
$3,098.22
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1 UNIT [200 UNIT VIAL]
|
Facility
|
OP
|
$7,041.40
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$6,759.74 |
| Rate for Payer: Aetna Commercial |
$5,421.88
|
| Rate for Payer: Anthem Medicaid |
$2,421.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$3,520.70
|
| Rate for Payer: Cash Price |
$3,520.70
|
| Rate for Payer: Cigna Commercial |
$5,844.36
|
| Rate for Payer: First Health Commercial |
$6,689.33
|
| Rate for Payer: Humana Commercial |
$5,985.19
|
| Rate for Payer: Humana KY Medicaid |
$2,421.54
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.83
|
| Rate for Payer: PHCS Commercial |
$6,759.74
|
| Rate for Payer: United Healthcare All Payer |
$6,196.43
|
|
|
BOTOX 1 UNIT [200 UNIT VIAL]
|
Facility
|
IP
|
$7,041.40
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001900
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$915.38 |
| Max. Negotiated Rate |
$6,759.74 |
| Rate for Payer: Aetna Commercial |
$5,421.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,492.29
|
| Rate for Payer: Cash Price |
$3,520.70
|
| Rate for Payer: Cigna Commercial |
$5,844.36
|
| Rate for Payer: First Health Commercial |
$6,689.33
|
| Rate for Payer: Humana Commercial |
$5,985.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,773.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,196.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,196.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.83
|
| Rate for Payer: PHCS Commercial |
$6,759.74
|
| Rate for Payer: United Healthcare All Payer |
$6,196.43
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
IP
|
$1,972.90
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$256.48 |
| Max. Negotiated Rate |
$1,893.98 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.86
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cigna Commercial |
$1,637.51
|
| Rate for Payer: First Health Commercial |
$1,874.26
|
| Rate for Payer: Humana Commercial |
$1,676.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.60
|
| Rate for Payer: PHCS Commercial |
$1,893.98
|
| Rate for Payer: United Healthcare All Payer |
$1,736.15
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.93
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
OP
|
$1,972.90
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$1,893.98 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Anthem Medicaid |
$678.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.54
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cigna Commercial |
$1,637.51
|
| Rate for Payer: First Health Commercial |
$1,874.26
|
| Rate for Payer: Humana Commercial |
$1,676.96
|
| Rate for Payer: Humana KY Medicaid |
$678.48
|
| Rate for Payer: Humana Medicare Advantage |
$6.33
|
| Rate for Payer: Kentucky WC Medicaid |
$685.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.60
|
| Rate for Payer: PHCS Commercial |
$1,893.98
|
| Rate for Payer: United Healthcare All Payer |
$1,736.15
|
|
