|
TELETHX ISODOSE PLAN SIMPLE(T
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
333T0008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$393.60 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
|
TEMODAR 1MG (100 MG VL)
|
Facility
|
IP
|
$5,466.95
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
25002681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$710.70 |
| Max. Negotiated Rate |
$5,248.27 |
| Rate for Payer: Aetna Commercial |
$4,209.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.22
|
| Rate for Payer: Cash Price |
$2,733.48
|
| Rate for Payer: Cigna Commercial |
$4,537.57
|
| Rate for Payer: First Health Commercial |
$5,193.60
|
| Rate for Payer: Humana Commercial |
$4,646.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,034.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,810.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.75
|
| Rate for Payer: PHCS Commercial |
$5,248.27
|
| Rate for Payer: United Healthcare All Payer |
$4,810.92
|
|
|
TEMODAR 1MG (100 MG VL)
|
Facility
|
OP
|
$5,466.95
|
|
|
Service Code
|
HCPCS J9328
|
| Hospital Charge Code |
25002681
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$5,248.27 |
| Rate for Payer: Aetna Commercial |
$4,209.55
|
| Rate for Payer: Anthem Medicaid |
$1,880.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,264.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.04
|
| Rate for Payer: Cash Price |
$2,733.48
|
| Rate for Payer: Cash Price |
$2,733.48
|
| Rate for Payer: Cigna Commercial |
$4,537.57
|
| Rate for Payer: First Health Commercial |
$5,193.60
|
| Rate for Payer: Humana Commercial |
$4,646.91
|
| Rate for Payer: Humana KY Medicaid |
$1,880.08
|
| Rate for Payer: Humana Medicare Advantage |
$10.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,482.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,034.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,917.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,810.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,100.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.75
|
| Rate for Payer: PHCS Commercial |
$5,248.27
|
| Rate for Payer: United Healthcare All Payer |
$4,810.92
|
|
|
TEMOVATE 0.05% CREAM 30GM
|
Facility
|
OP
|
$3.17
|
|
|
Service Code
|
NDC 51672125802
|
| Hospital Charge Code |
25001505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Anthem Medicaid |
$1.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.47
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna Commercial |
$2.63
|
| Rate for Payer: First Health Commercial |
$3.01
|
| Rate for Payer: Humana Commercial |
$2.69
|
| Rate for Payer: Humana KY Medicaid |
$1.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.79
|
| Rate for Payer: Ohio Health Group HMO |
$2.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.98
|
| Rate for Payer: PHCS Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Payer |
$2.79
|
|
|
TEMOVATE 0.05% CREAM 30GM
|
Facility
|
IP
|
$3.17
|
|
|
Service Code
|
NDC 51672125802
|
| Hospital Charge Code |
25001505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.47
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cigna Commercial |
$2.63
|
| Rate for Payer: First Health Commercial |
$3.01
|
| Rate for Payer: Humana Commercial |
$2.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.79
|
| Rate for Payer: Ohio Health Group HMO |
$2.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.98
|
| Rate for Payer: PHCS Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Payer |
$2.79
|
|
|
TEMOVATE 0.05% OINTMENT 30GM
|
Facility
|
OP
|
$2.83
|
|
|
Service Code
|
NDC 21922001705
|
| Hospital Charge Code |
25001504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Anthem Medicaid |
$0.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.21
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna Commercial |
$2.35
|
| Rate for Payer: First Health Commercial |
$2.69
|
| Rate for Payer: Humana Commercial |
$2.41
|
| Rate for Payer: Humana KY Medicaid |
$0.97
|
| Rate for Payer: Kentucky WC Medicaid |
$0.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.49
|
| Rate for Payer: Ohio Health Group HMO |
$2.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.88
|
| Rate for Payer: PHCS Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Payer |
$2.49
|
|
|
TEMOVATE 0.05% OINTMENT 30GM
|
Facility
|
IP
|
$2.83
|
|
|
Service Code
|
NDC 21922001705
|
| Hospital Charge Code |
25001504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.21
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cigna Commercial |
$2.35
|
| Rate for Payer: First Health Commercial |
$2.69
|
| Rate for Payer: Humana Commercial |
$2.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.49
|
| Rate for Payer: Ohio Health Group HMO |
$2.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.88
|
| Rate for Payer: PHCS Commercial |
$2.72
|
| Rate for Payer: United Healthcare All Payer |
$2.49
|
|
|
TEMPO ST. 5F 65CM
|
Facility
|
IP
|
$1,538.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.04 |
| Max. Negotiated Rate |
$1,477.20 |
| Rate for Payer: Aetna Commercial |
$1,184.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.22
|
| Rate for Payer: Cash Price |
$769.38
|
| Rate for Payer: Cigna Commercial |
$1,277.16
|
| Rate for Payer: First Health Commercial |
$1,461.81
|
| Rate for Payer: Humana Commercial |
$1,307.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,354.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,154.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.01
|
| Rate for Payer: PHCS Commercial |
$1,477.20
|
| Rate for Payer: United Healthcare All Payer |
$1,354.10
|
|
|
TEMPO ST. 5F 65CM
|
Facility
|
OP
|
$1,538.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.04 |
| Max. Negotiated Rate |
$1,477.20 |
| Rate for Payer: Aetna Commercial |
$1,184.84
|
| Rate for Payer: Anthem Medicaid |
$529.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.22
|
| Rate for Payer: Cash Price |
$769.38
|
| Rate for Payer: Cigna Commercial |
$1,277.16
|
| Rate for Payer: First Health Commercial |
$1,461.81
|
| Rate for Payer: Humana Commercial |
$1,307.94
|
| Rate for Payer: Humana KY Medicaid |
$529.18
|
| Rate for Payer: Kentucky WC Medicaid |
$534.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,354.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,154.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.01
|
| Rate for Payer: PHCS Commercial |
$1,477.20
|
| Rate for Payer: United Healthcare All Payer |
$1,354.10
|
|
|
TEMP TRANSCUTANEOUS PACING
|
Professional
|
Both
|
$1,218.49
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
76102466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$1,218.49 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Anthem Medicaid |
$28.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,218.49
|
| Rate for Payer: Cash Price |
$609.24
|
| Rate for Payer: Cash Price |
$609.24
|
| Rate for Payer: Cigna Commercial |
$18.15
|
| Rate for Payer: Healthspan PPO |
$18.74
|
| Rate for Payer: Humana Medicaid |
$28.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.66
|
| Rate for Payer: Molina Healthcare Passport |
$28.10
|
| Rate for Payer: Multiplan PHCS |
$731.09
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$852.94
|
| Rate for Payer: UHCCP Medicaid |
$426.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.38
|
|
|
TEMP TRANSCUTANEOUS PACING
|
Facility
|
OP
|
$1,218.49
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
76102466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$1,169.75 |
| Rate for Payer: Aetna Commercial |
$938.24
|
| Rate for Payer: Anthem Medicaid |
$419.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$562.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$787.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.78
|
| Rate for Payer: Cash Price |
$609.24
|
| Rate for Payer: Cash Price |
$609.24
|
| Rate for Payer: Cigna Commercial |
$1,011.35
|
| Rate for Payer: First Health Commercial |
$1,157.57
|
| Rate for Payer: Humana Commercial |
$1,035.72
|
| Rate for Payer: Humana KY Medicaid |
$419.04
|
| Rate for Payer: Humana Medicare Advantage |
$562.80
|
| Rate for Payer: Kentucky WC Medicaid |
$423.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$999.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.27
|
| Rate for Payer: Ohio Health Group HMO |
$913.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.73
|
| Rate for Payer: PHCS Commercial |
$1,169.75
|
| Rate for Payer: United Healthcare All Payer |
$1,072.27
|
|
|
TEMP TRANSCUTANEOUS PACING
|
Facility
|
IP
|
$1,218.49
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
76102466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$1,169.75 |
| Rate for Payer: Aetna Commercial |
$938.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.42
|
| Rate for Payer: Cash Price |
$609.24
|
| Rate for Payer: Cigna Commercial |
$1,011.35
|
| Rate for Payer: First Health Commercial |
$1,157.57
|
| Rate for Payer: Humana Commercial |
$1,035.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$999.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.27
|
| Rate for Payer: Ohio Health Group HMO |
$913.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$377.73
|
| Rate for Payer: PHCS Commercial |
$1,169.75
|
| Rate for Payer: United Healthcare All Payer |
$1,072.27
|
|
|
TEMP TRANSCUTANEOUS PACING(P
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
761P2466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Anthem Medicaid |
$28.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$320.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$18.15
|
| Rate for Payer: Healthspan PPO |
$18.74
|
| Rate for Payer: Humana Medicaid |
$28.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.66
|
| Rate for Payer: Molina Healthcare Passport |
$28.10
|
| Rate for Payer: Multiplan PHCS |
$192.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.00
|
| Rate for Payer: UHCCP Medicaid |
$112.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.38
|
|
|
TEMP TRANSCUTANEOUS PACING(T
|
Facility
|
OP
|
$898.49
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
761T2466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$862.55 |
| Rate for Payer: Aetna Commercial |
$691.84
|
| Rate for Payer: Anthem Medicaid |
$308.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$562.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$787.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.78
|
| Rate for Payer: Cash Price |
$449.24
|
| Rate for Payer: Cash Price |
$449.24
|
| Rate for Payer: Cigna Commercial |
$745.75
|
| Rate for Payer: First Health Commercial |
$853.57
|
| Rate for Payer: Humana Commercial |
$763.72
|
| Rate for Payer: Humana KY Medicaid |
$308.99
|
| Rate for Payer: Humana Medicare Advantage |
$562.80
|
| Rate for Payer: Kentucky WC Medicaid |
$312.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.67
|
| Rate for Payer: Ohio Health Group HMO |
$673.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.53
|
| Rate for Payer: PHCS Commercial |
$862.55
|
| Rate for Payer: United Healthcare All Payer |
$790.67
|
|
|
TEMP TRANSCUTANEOUS PACING(T
|
Facility
|
IP
|
$898.49
|
|
|
Service Code
|
HCPCS 92953
|
| Hospital Charge Code |
761T2466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$862.55 |
| Rate for Payer: Aetna Commercial |
$691.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$700.82
|
| Rate for Payer: Cash Price |
$449.24
|
| Rate for Payer: Cigna Commercial |
$745.75
|
| Rate for Payer: First Health Commercial |
$853.57
|
| Rate for Payer: Humana Commercial |
$763.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$736.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$663.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$790.67
|
| Rate for Payer: Ohio Health Group HMO |
$673.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.53
|
| Rate for Payer: PHCS Commercial |
$862.55
|
| Rate for Payer: United Healthcare All Payer |
$790.67
|
|
|
TENDON EXCISION PALM/FINGER
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
76100677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
TENDON EXCISION PALM/FINGER
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
76100677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$731.19
|
| Rate for Payer: Anthem Medicaid |
$322.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$809.90
|
| Rate for Payer: Healthspan PPO |
$662.30
|
| Rate for Payer: Humana Medicaid |
$322.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.16
|
| Rate for Payer: Molina Healthcare Passport |
$322.71
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.94
|
|
|
TENDON EXCISION PALM/FINGER
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
76100677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
TENDON EXCISION PALM/FINGER(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
761P0677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$731.19
|
| Rate for Payer: Anthem Medicaid |
$322.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$809.90
|
| Rate for Payer: Healthspan PPO |
$662.30
|
| Rate for Payer: Humana Medicaid |
$322.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.16
|
| Rate for Payer: Molina Healthcare Passport |
$322.71
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.94
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITH MCC
|
Facility
|
IP
|
$18,211.76
|
|
|
Service Code
|
MSDRG 557
|
| Min. Negotiated Rate |
$12,357.98 |
| Max. Negotiated Rate |
$18,211.76 |
| Rate for Payer: Anthem Medicaid |
$12,357.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,008.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,211.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,561.34
|
| Rate for Payer: Humana KY Medicaid |
$12,357.98
|
| Rate for Payer: Humana Medicare Advantage |
$13,008.40
|
| Rate for Payer: Kentucky WC Medicaid |
$12,481.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,610.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,605.14
|
|
|
TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC
|
Facility
|
IP
|
$10,275.71
|
|
|
Service Code
|
MSDRG 558
|
| Min. Negotiated Rate |
$6,972.80 |
| Max. Negotiated Rate |
$10,275.71 |
| Rate for Payer: Anthem Medicaid |
$6,972.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,339.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,275.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,908.72
|
| Rate for Payer: Humana KY Medicaid |
$6,972.80
|
| Rate for Payer: Humana Medicare Advantage |
$7,339.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,042.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,807.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,112.26
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
TENDON SHORTENING
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
TENDON SHORTENING
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$998.85 |
| Rate for Payer: Aetna Commercial |
$806.92
|
| Rate for Payer: Anthem Medicaid |
$270.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$998.85
|
| Rate for Payer: Healthspan PPO |
$730.90
|
| Rate for Payer: Humana Medicaid |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$700.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.01
|
| Rate for Payer: Molina Healthcare Passport |
$270.60
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.31
|
|
|
TENDON SHORTENING
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
