|
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
|
$59.68
|
|
|
Service Code
|
CPT 96375
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$59.68 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$57.55
|
| Rate for Payer: Humana Medicare Advantage |
$42.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.16
|
|
|
THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); INTRAVENOUS PUSH, SINGLE OR INITIAL SUBSTANCE/DRUG
|
Facility
|
OP
|
$272.54
|
|
|
Service Code
|
CPT 96374
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$272.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
|
|
THER FX NASAL INF TURBINATE
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
76101143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| 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: 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 |
$114.00
|
| 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 |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| 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 |
$228.00 |
| Rate for Payer: Aetna Commercial |
$170.22
|
| Rate for Payer: Ambetter Exchange |
$110.27
|
| Rate for Payer: Anthem Medicaid |
$56.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$110.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.27
|
| 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 |
$143.35
|
| Rate for Payer: UHCCP Medicaid |
$133.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.27
|
|
|
THER FX NASAL INF TURBINATE
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
76101143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Anthem Medicaid |
$130.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$296.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.20
|
| Rate for Payer: PHCS Commercial |
$364.80
|
| Rate for Payer: United Healthcare All Payer |
$334.40
|
|
|
THER FX NASAL INF TURBINATE(P
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 30930
|
| Hospital Charge Code |
761P1143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$170.22
|
| Rate for Payer: Ambetter Exchange |
$110.27
|
| Rate for Payer: Anthem Medicaid |
$56.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$110.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.27
|
| 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 |
$143.35
|
| Rate for Payer: UHCCP Medicaid |
$133.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$57.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.27
|
|
|
THER IVNTJ 1ST 15 MIN OT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ 1ST 15 MIN OT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000039
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ 1ST 15 MIN PT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
42000070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ 1ST 15 MIN PT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
42000070
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ 1ST 15 MIN SP
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
44000050
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
THER IVNTJ 1ST 15 MIN SP
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
44000050
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.05
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
|
THER IVNTJ EA ADDL 15 MIN OT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
43000040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ EA ADDL 15 MIN OT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
43000040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ EA ADDL 15 MIN PT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
42000071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ EA ADDL 15 MIN PT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
42000071
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
THER IVNTJ EA ADDL 15 MIN SP
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
44000051
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$15.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.88
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$15.82
|
| Rate for Payer: Kentucky WC Medicaid |
$15.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
THER IVNTJ EA ADDL 15 MIN SP
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 97130
|
| Hospital Charge Code |
44000051
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.88
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.74
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
THERMOACTINOMYCES VULGARIS IGG
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.72
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
THERMOACTINOMYCES VULGARIS IGG
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 86609
|
| Hospital Charge Code |
30001110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.72
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
THERMODILATION CATH 110CM 7FR
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
THERMODILATION CATH 110CM 7FR
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
26000022
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.86
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
26000022
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$194.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$272.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$262.80
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Humana KY Medicaid |
$101.11
|
| Rate for Payer: Humana Medicare Advantage |
$194.67
|
| Rate for Payer: Kentucky WC Medicaid |
$102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.86
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
THER/PROPH/DIAG INJ IV PUSH
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 96374
|
| Hospital Charge Code |
26000022
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.54 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$82.28
|
| Rate for Payer: Ambetter Exchange |
$31.54
|
| Rate for Payer: Anthem Medicaid |
$44.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.85
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$73.07
|
| Rate for Payer: Healthspan PPO |
$77.10
|
| Rate for Payer: Humana Medicaid |
$44.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.40
|
| Rate for Payer: Molina Healthcare Passport |
$44.51
|
| Rate for Payer: Multiplan PHCS |
$176.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.00
|
| Rate for Payer: UHCCP Medicaid |
$102.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.54
|
|
