|
THERAGRAN (MULTIVITAMIN) 1TAB
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 904053961
|
| Hospital Charge Code |
25001525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.52
|
| Rate for Payer: First Health Commercial |
$4.03
|
| Rate for Payer: Humana Commercial |
$3.60
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.73
|
| Rate for Payer: Ohio Health Group HMO |
$3.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.07
|
| Rate for Payer: United Healthcare All Payer |
$3.73
|
|
|
THERAPEUTI APHERESIS RBC
|
Facility
|
OP
|
$1,896.00
|
|
|
Service Code
|
HCPCS 36512
|
| Hospital Charge Code |
76101469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.03 |
| Max. Negotiated Rate |
$2,120.52 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,514.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,120.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,044.79
|
| 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 |
$1,514.66
|
| 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 |
$1,817.59
|
| 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 |
$1,516.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.24
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
THERAPEUTI APHERESIS RBC
|
Facility
|
IP
|
$1,896.00
|
|
|
Service Code
|
HCPCS 36512
|
| Hospital Charge Code |
76101469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$568.80 |
| 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 |
$1,516.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.24
|
| Rate for Payer: PHCS Commercial |
$1,820.16
|
| Rate for Payer: United Healthcare All Payer |
$1,668.48
|
|
|
THERAPEUTIC ACTIV-15 MIN
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
THERAPEUTIC ACTIV-15 MIN
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
THERAPEUTIC ACTIVITIES-15 MINS
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
THERAPEUTIC ACTIVITIES-15 MINS
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 97530
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Facility
|
IP
|
$2,405.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.50 |
| Max. Negotiated Rate |
$2,308.80 |
| Rate for Payer: Aetna Commercial |
$1,851.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,875.90
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Cigna Commercial |
$1,996.15
|
| Rate for Payer: First Health Commercial |
$2,284.75
|
| Rate for Payer: Humana Commercial |
$2,044.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,972.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,774.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$721.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,116.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,803.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,092.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.45
|
| Rate for Payer: PHCS Commercial |
$2,308.80
|
| Rate for Payer: United Healthcare All Payer |
$2,116.40
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Professional
|
Both
|
$2,405.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.81 |
| Max. Negotiated Rate |
$1,443.00 |
| Rate for Payer: Aetna Commercial |
$138.26
|
| Rate for Payer: Ambetter Exchange |
$87.47
|
| 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 Individual/Medicaid |
$87.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.96
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Cash Price |
$1,202.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$87.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.01
|
| Rate for Payer: Molina Healthcare Passport |
$69.62
|
| Rate for Payer: Multiplan PHCS |
$1,443.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.71
|
| Rate for Payer: UHCCP Medicaid |
$54.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.47
|
|
|
THERAPEUTIC APHERESIS PLASMA
|
Facility
|
OP
|
$2,405.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
76101471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.08 |
| Max. Negotiated Rate |
$2,308.80 |
| Rate for Payer: Aetna Commercial |
$1,851.85
|
| Rate for Payer: Anthem Medicaid |
$827.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,514.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,875.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,120.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,044.79
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Cash Price |
$1,202.50
|
| Rate for Payer: Cigna Commercial |
$1,996.15
|
| Rate for Payer: First Health Commercial |
$2,284.75
|
| Rate for Payer: Humana Commercial |
$2,044.25
|
| Rate for Payer: Humana KY Medicaid |
$827.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,514.66
|
| Rate for Payer: Kentucky WC Medicaid |
$835.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,972.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,774.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,817.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$843.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,116.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,803.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,092.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,659.45
|
| Rate for Payer: PHCS Commercial |
$2,308.80
|
| Rate for Payer: United Healthcare All Payer |
$2,116.40
|
|
|
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: Ambetter Exchange |
$87.47
|
| 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 Individual/Medicaid |
$87.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$87.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.47
|
| 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 |
$113.71
|
| Rate for Payer: UHCCP Medicaid |
$54.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.47
|
|
|
THERAPEUTIC APHERESIS PLASMA(T
|
Facility
|
OP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
761T1471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.91 |
| Max. Negotiated Rate |
$2,120.52 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem Medicaid |
$723.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,514.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,120.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,044.79
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Humana KY Medicaid |
$723.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,514.66
|
| Rate for Payer: Kentucky WC Medicaid |
$731.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,817.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
THERAPEUTIC APHERESIS PLASMA(T
|
Facility
|
IP
|
$2,105.00
|
|
|
Service Code
|
HCPCS 36514
|
| Hospital Charge Code |
761T1471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.50 |
| Max. Negotiated Rate |
$2,020.80 |
| Rate for Payer: Aetna Commercial |
$1,620.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,641.90
|
| Rate for Payer: Cash Price |
$1,052.50
|
| Rate for Payer: Cigna Commercial |
$1,747.15
|
| Rate for Payer: First Health Commercial |
$1,999.75
|
| Rate for Payer: Humana Commercial |
$1,789.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,578.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.45
|
| Rate for Payer: PHCS Commercial |
$2,020.80
|
| Rate for Payer: United Healthcare All Payer |
$1,852.40
|
|
|
THERAPEUTIC APHERESIS PLATELET
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
HCPCS 36513
|
| Hospital Charge Code |
76101470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.95 |
| 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 |
$403.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,307.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$565.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.33
|
| 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 |
$403.95
|
| 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 |
$484.74
|
| 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 |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,458.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.44
|
| 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 |
$502.80 |
| 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 |
$1,340.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,458.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.44
|
| 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 |
$652.03 |
| Max. Negotiated Rate |
$2,120.52 |
| Rate for Payer: Aetna Commercial |
$1,459.92
|
| Rate for Payer: Anthem Medicaid |
$652.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,514.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,120.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,044.79
|
| 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 |
$1,514.66
|
| 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 |
$1,817.59
|
| 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 |
$1,516.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.24
|
| 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 |
$568.80 |
| 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 |
$1,516.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,649.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.24
|
| 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
|
$150.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
44000018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
THERAPEUTIC EXERCISE EA 15 MIN
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 97110
|
| Hospital Charge Code |
44000018
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$400.80 |
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Ambetter Exchange |
$53.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$46.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.48
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cigna Commercial |
$123.02
|
| Rate for Payer: Healthspan PPO |
$99.22
|
| Rate for Payer: Humana Medicaid |
$46.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.31
|
| Rate for Payer: Molina Healthcare Passport |
$46.38
|
| Rate for Payer: Multiplan PHCS |
$400.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.85
|
| Rate for Payer: UHCCP Medicaid |
$36.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.73
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.73 |
| Max. Negotiated Rate |
$641.28 |
| Rate for Payer: Aetna Commercial |
$514.36
|
| Rate for Payer: Anthem Medicaid |
$229.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cigna Commercial |
$554.44
|
| Rate for Payer: First Health Commercial |
$634.60
|
| Rate for Payer: Humana Commercial |
$567.80
|
| Rate for Payer: Humana KY Medicaid |
$229.73
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.84
|
| Rate for Payer: Ohio Health Group HMO |
$501.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.92
|
| Rate for Payer: PHCS Commercial |
$641.28
|
| Rate for Payer: United Healthcare All Payer |
$587.84
|
|
|
THERAPEUTIC INJ CARPAL TUNNEL
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$641.28 |
| Rate for Payer: Aetna Commercial |
$514.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.04
|
| Rate for Payer: Cash Price |
$334.00
|
| Rate for Payer: Cigna Commercial |
$554.44
|
| Rate for Payer: First Health Commercial |
$634.60
|
| Rate for Payer: Humana Commercial |
$567.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$547.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$587.84
|
| Rate for Payer: Ohio Health Group HMO |
$501.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.92
|
| Rate for Payer: PHCS Commercial |
$641.28
|
| Rate for Payer: United Healthcare All Payer |
$587.84
|
|
|
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 |
$123.02 |
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Ambetter Exchange |
$53.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$46.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.48
|
| 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 |
$46.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.31
|
| Rate for Payer: Molina Healthcare Passport |
$46.38
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.85
|
| Rate for Payer: UHCCP Medicaid |
$36.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.73
|
|
|
THERAPEUTIC INJ CARPAL TUNNE(T
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
761T0336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.14 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem Medicaid |
$178.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Humana KY Medicaid |
$178.14
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$179.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
THERAPEUTIC INJ CARPAL TUNNE(T
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 20526
|
| Hospital Charge Code |
761T0336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
