|
THERAPEUTIC ACTIV-15 MIN
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
THERAPEUTIC ACTIVITIES-15 MINS
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
THERAPEUTIC ACTIVITIES-15 MINS
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$44.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.62
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$44.36
|
| Rate for Payer: Kentucky WC Medicaid |
$44.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.99
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.01 |
| Max. Negotiated Rate |
$2,185.92 |
| Rate for Payer: Aetna Commercial |
$1,753.29
|
| Rate for Payer: Anthem Medicaid |
$783.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,326.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,776.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,857.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,791.19
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$1,889.91
|
| Rate for Payer: First Health Commercial |
$2,163.15
|
| Rate for Payer: Humana Commercial |
$1,935.45
|
| Rate for Payer: Humana KY Medicaid |
$783.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,326.81
|
| Rate for Payer: Kentucky WC Medicaid |
$791.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,867.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,680.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,592.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$798.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,003.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,707.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$705.87
|
| Rate for Payer: PHCS Commercial |
$2,185.92
|
| Rate for Payer: United Healthcare All Payer |
$2,003.76
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.01 |
| Max. Negotiated Rate |
$2,185.92 |
| Rate for Payer: Aetna Commercial |
$1,753.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,776.06
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$1,889.91
|
| Rate for Payer: First Health Commercial |
$2,163.15
|
| Rate for Payer: Humana Commercial |
$1,935.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,867.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,680.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$683.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,003.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,707.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$705.87
|
| Rate for Payer: PHCS Commercial |
$2,185.92
|
| Rate for Payer: United Healthcare All Payer |
$2,003.76
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Professional
|
Both
|
$2,277.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$2,277.00 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.81
|
| Rate for Payer: Anthem Medicaid |
$69.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,277.00
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$133.59
|
| Rate for Payer: Healthspan PPO |
$594.57
|
| Rate for Payer: Humana Medicaid |
$69.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.01
|
| Rate for Payer: Molina Healthcare Passport |
$69.62
|
| Rate for Payer: Multiplan PHCS |
$1,366.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,593.90
|
| Rate for Payer: UHCCP Medicaid |
$54.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.32
|
|
|
THERAPEUTIC APHERESIS PLASMA(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
761P1471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$594.57 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$51.81
|
| Rate for Payer: Anthem Medicaid |
$69.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$133.59
|
| Rate for Payer: Healthspan PPO |
$594.57
|
| Rate for Payer: Humana Medicaid |
$69.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$119.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.01
|
| Rate for Payer: Molina Healthcare Passport |
$69.62
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$54.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.32
|
|
|
THERAPEUTIC APHERESIS PLASMA(T
|
Facility
|
IP
|
$1,977.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
761T1471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.01 |
| Max. Negotiated Rate |
$1,897.92 |
| Rate for Payer: Aetna Commercial |
$1,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.06
|
| Rate for Payer: Cash Price |
$988.50
|
| Rate for Payer: Cigna Commercial |
$1,640.91
|
| Rate for Payer: First Health Commercial |
$1,878.15
|
| Rate for Payer: Humana Commercial |
$1,680.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,739.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.87
|
| Rate for Payer: PHCS Commercial |
$1,897.92
|
| Rate for Payer: United Healthcare All Payer |
$1,739.76
|
|
|
THERAPEUTIC APHERESIS PLASMA(T
|
Facility
|
OP
|
$1,977.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
761T1471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.01 |
| Max. Negotiated Rate |
$1,897.92 |
| Rate for Payer: Aetna Commercial |
$1,522.29
|
| Rate for Payer: Anthem Medicaid |
$679.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,326.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,857.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,791.19
|
| Rate for Payer: Cash Price |
$988.50
|
| Rate for Payer: Cash Price |
$988.50
|
| Rate for Payer: Cigna Commercial |
$1,640.91
|
| Rate for Payer: First Health Commercial |
$1,878.15
|
| Rate for Payer: Humana Commercial |
$1,680.45
|
| Rate for Payer: Humana KY Medicaid |
$679.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,326.81
|
| Rate for Payer: Kentucky WC Medicaid |
$686.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,592.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,739.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.87
|
| Rate for Payer: PHCS Commercial |
$1,897.92
|
| Rate for Payer: United Healthcare All Payer |
$1,739.76
|
|
|
THERAPEUTIC APHERESIS PLATELET
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 36513
|
| Hospital Charge Code |
76101470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.88 |
| Max. Negotiated Rate |
$1,608.96 |
| Rate for Payer: Aetna Commercial |
$1,290.52
|
| Rate for Payer: Anthem Medicaid |
$576.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$375.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,307.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$525.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$506.78
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,391.08
|
| Rate for Payer: First Health Commercial |
$1,592.20
|
| Rate for Payer: Humana Commercial |
$1,424.60
|
| Rate for Payer: Humana KY Medicaid |
$576.38
|
| Rate for Payer: Humana Medicare Advantage |
$375.39
|
| Rate for Payer: Kentucky WC Medicaid |
$582.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,374.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$587.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,257.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.56
|
| Rate for Payer: PHCS Commercial |
$1,608.96
|
| Rate for Payer: United Healthcare All Payer |
$1,474.88
|
|
|
THERAPEUTIC APHERESIS PLATELET
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 36513
|
| Hospital Charge Code |
76101470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.88 |
| Max. Negotiated Rate |
$1,608.96 |
| Rate for Payer: Aetna Commercial |
$1,290.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,307.28
|
| Rate for Payer: Cash Price |
$838.00
|
| Rate for Payer: Cigna Commercial |
$1,391.08
|
| Rate for Payer: First Health Commercial |
$1,592.20
|
| Rate for Payer: Humana Commercial |
$1,424.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,374.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$502.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,257.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.56
|
| Rate for Payer: PHCS Commercial |
$1,608.96
|
| Rate for Payer: United Healthcare All Payer |
$1,474.88
|
|
|
THERAPEUTIC APHERESIS WBC
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS 36511
|
| Hospital Charge Code |
76101468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,857.53 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,326.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,857.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,791.19
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Humana KY Medicaid |
$652.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,326.81
|
| Rate for Payer: Kentucky WC Medicaid |
$658.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,592.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
THERAPEUTIC APHERESIS WBC
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS 36511
|
| Hospital Charge Code |
76101468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.48 |
| Max. Negotiated Rate |
$1,820.16 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cigna Commercial |
$1,573.68
|
| Rate for Payer: First Health Commercial |
$1,801.20
|
| Rate for Payer: Humana Commercial |
$1,611.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,399.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,668.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.76
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
THERAPEUTIC EXERCISE EA 15 MIN
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
44000018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
THERAPEUTIC EXERCISE EA 15 MIN
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
44000018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$50.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$50.21
|
| Rate for Payer: Kentucky WC Medicaid |
$50.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$636.00 |
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$636.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$123.02
|
| Rate for Payer: Healthspan PPO |
$99.22
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$381.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$445.20
|
| Rate for Payer: UHCCP Medicaid |
$36.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Facility
|
IP
|
$636.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$610.56 |
| Rate for Payer: Aetna Commercial |
$489.72
|
| Rate for Payer: Anthem Medicaid |
$218.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$527.88
|
| Rate for Payer: First Health Commercial |
$604.20
|
| Rate for Payer: Humana Commercial |
$540.60
|
| Rate for Payer: Humana KY Medicaid |
$218.72
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$220.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$521.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$469.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$559.68
|
| Rate for Payer: Ohio Health Group HMO |
$477.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.16
|
| Rate for Payer: PHCS Commercial |
$610.56
|
| Rate for Payer: United Healthcare All Payer |
$559.68
|
|
|
THERAPEUTIC INJ CARPAL TUNNE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
761P0336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$36.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$123.02
|
| Rate for Payer: Healthspan PPO |
$99.22
|
| Rate for Payer: Humana Medicaid |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.05
|
| Rate for Payer: Molina Healthcare Passport |
$36.32
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$36.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.68
|
|
|
THERAPEUTIC INJ CARPAL TUNNE(T
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
761T0336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem Medicaid |
$167.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Humana KY Medicaid |
$167.14
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$168.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
THERAPEUTIC INJ CARPAL TUNNE(T
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
761T0336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$374.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.08
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$403.38
|
| Rate for Payer: First Health Commercial |
$461.70
|
| Rate for Payer: Humana Commercial |
$413.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$398.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$358.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$427.68
|
| Rate for Payer: Ohio Health Group HMO |
$364.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.66
|
| Rate for Payer: PHCS Commercial |
$466.56
|
| Rate for Payer: United Healthcare All Payer |
$427.68
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL SEQUENTIAL INTRAVENOUS PUSH OF A NEW SUBSTANCE/DRUG (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$57.51
|
|
|
Service Code
|
CPT 96375
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$57.51 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.46
|
| Rate for Payer: Humana Medicare Advantage |
$41.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.30
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); INTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG
|
Facility
|
OP
|
$259.49
|
|
|
Service Code
|
CPT 96374
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.35 |
| Max. Negotiated Rate |
$259.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
|
|
THER FX NASAL INF TURBINATE
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
76101143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: First Health Commercial |
$361.00
|
| Rate for Payer: Humana Commercial |
$323.00
|
| Rate for Payer: Humana KY Medicaid |
$130.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$132.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$311.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$334.40
|
| Rate for Payer: Ohio Health Group HMO |
$285.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.80
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
THER FX NASAL INF TURBINATE
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
76101143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$170.22
|
| Rate for Payer: Anthem Medicaid |
$56.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cash Price |
$190.00
|
| Rate for Payer: Cigna Commercial |
$167.17
|
| Rate for Payer: Healthspan PPO |
$143.55
|
| Rate for Payer: Humana Medicaid |
$56.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.62
|
| Rate for Payer: Molina Healthcare Passport |
$56.49
|
| Rate for Payer: Multiplan PHCS |
$228.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$266.00
|
| Rate for Payer: UHCCP Medicaid |
$133.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.05
|
|
