|
BONE MARROW ASP W/ BX
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000242
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
45000243
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX(P
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761P1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$92.67
|
| Rate for Payer: Ambetter Exchange |
$63.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.38
|
| Rate for Payer: Anthem Medicaid |
$151.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$75.70
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$87.68
|
| Rate for Payer: Healthspan PPO |
$178.94
|
| Rate for Payer: Humana Medicaid |
$151.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.63
|
| Rate for Payer: Molina Healthcare Passport |
$151.60
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.00
|
| Rate for Payer: UHCCP Medicaid |
$44.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.08
|
|
|
BONE MARROW ASP W/ BX(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761T1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW ASP W/ BX(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 38220
|
| Hospital Charge Code |
761T1588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761T1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
45000244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$676.11 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761T1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$676.11 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
45000244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$1,354.20 |
| Rate for Payer: Aetna Commercial |
$117.79
|
| Rate for Payer: Ambetter Exchange |
$65.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.82
|
| Rate for Payer: Anthem Medicaid |
$162.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.10
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$111.33
|
| Rate for Payer: Healthspan PPO |
$199.46
|
| Rate for Payer: Humana Medicaid |
$162.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.04
|
| Rate for Payer: Molina Healthcare Passport |
$162.78
|
| Rate for Payer: Multiplan PHCS |
$1,354.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.60
|
| Rate for Payer: UHCCP Medicaid |
$37.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
761P1589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$199.46 |
| Rate for Payer: Aetna Commercial |
$117.79
|
| Rate for Payer: Ambetter Exchange |
$65.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.82
|
| Rate for Payer: Anthem Medicaid |
$162.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$78.10
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$111.33
|
| Rate for Payer: Healthspan PPO |
$199.46
|
| Rate for Payer: Humana Medicaid |
$162.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.04
|
| Rate for Payer: Molina Healthcare Passport |
$162.78
|
| Rate for Payer: Multiplan PHCS |
$174.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.60
|
| Rate for Payer: UHCCP Medicaid |
$37.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.08
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
OP
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$776.18 |
| Max. Negotiated Rate |
$2,166.72 |
| Rate for Payer: Aetna Commercial |
$1,737.89
|
| Rate for Payer: Anthem Medicaid |
$776.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,760.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$1,873.31
|
| Rate for Payer: First Health Commercial |
$2,144.15
|
| Rate for Payer: Humana Commercial |
$1,918.45
|
| Rate for Payer: Humana KY Medicaid |
$776.18
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$784.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,850.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,665.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$791.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,986.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.33
|
| Rate for Payer: PHCS Commercial |
$2,166.72
|
| Rate for Payer: United Healthcare All Payer |
$1,986.16
|
|
|
BONE MARROW BIOPNEED OR TROCAR
|
Facility
|
IP
|
$2,257.00
|
|
|
Service Code
|
HCPCS 38221
|
| Hospital Charge Code |
76101589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.10 |
| Max. Negotiated Rate |
$2,166.72 |
| Rate for Payer: Aetna Commercial |
$1,737.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,760.46
|
| Rate for Payer: Cash Price |
$1,128.50
|
| Rate for Payer: Cigna Commercial |
$1,873.31
|
| Rate for Payer: First Health Commercial |
$2,144.15
|
| Rate for Payer: Humana Commercial |
$1,918.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,850.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,665.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$677.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,986.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,557.33
|
| Rate for Payer: PHCS Commercial |
$2,166.72
|
| Rate for Payer: United Healthcare All Payer |
$1,986.16
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Facility
|
OP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,374.57 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem Medicaid |
$1,374.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Humana KY Medicaid |
$1,374.57
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,388.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,477.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,757.93
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Professional
|
Both
|
$3,997.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$2,398.20 |
| Rate for Payer: Ambetter Exchange |
$70.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.44
|
| Rate for Payer: Anthem Medicaid |
$130.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.10
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$271.92
|
| Rate for Payer: Humana Medicaid |
$130.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.81
|
| Rate for Payer: Molina Healthcare Passport |
$130.21
|
| Rate for Payer: Multiplan PHCS |
$2,398.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.10
|
| Rate for Payer: UHCCP Medicaid |
$65.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
|
|
BONE MARROW BIOPSY & ASPIRATN
|
Facility
|
IP
|
$3,997.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
76101590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,199.10 |
| Max. Negotiated Rate |
$3,837.12 |
| Rate for Payer: Aetna Commercial |
$3,077.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,117.66
|
| Rate for Payer: Cash Price |
$1,998.50
|
| Rate for Payer: Cigna Commercial |
$3,317.51
|
| Rate for Payer: First Health Commercial |
$3,797.15
|
| Rate for Payer: Humana Commercial |
$3,397.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,277.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,949.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,517.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,997.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,477.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,757.93
|
| Rate for Payer: PHCS Commercial |
$3,837.12
|
| Rate for Payer: United Healthcare All Payer |
$3,517.36
|
|
|
BONE MARROW BIOPSY & ASPIRAT(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761P1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$271.92 |
| Rate for Payer: Ambetter Exchange |
$70.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$62.44
|
| Rate for Payer: Anthem Medicaid |
$130.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.10
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$271.92
|
| Rate for Payer: Humana Medicaid |
$130.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.81
|
| Rate for Payer: Molina Healthcare Passport |
$130.21
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.10
|
| Rate for Payer: UHCCP Medicaid |
$65.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.08
|
|
|
BONE MARROW BIOPSY & ASPIRAT(T
|
Facility
|
OP
|
$3,817.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761T1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,312.67 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,939.09
|
| Rate for Payer: Anthem Medicaid |
$1,312.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,977.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,908.50
|
| Rate for Payer: Cash Price |
$1,908.50
|
| Rate for Payer: Cigna Commercial |
$3,168.11
|
| Rate for Payer: First Health Commercial |
$3,626.15
|
| Rate for Payer: Humana Commercial |
$3,244.45
|
| Rate for Payer: Humana KY Medicaid |
$1,312.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,326.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,129.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,816.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,358.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,862.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,320.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.73
|
| Rate for Payer: PHCS Commercial |
$3,664.32
|
| Rate for Payer: United Healthcare All Payer |
$3,358.96
|
|
|
BONE MARROW BIOPSY & ASPIRAT(T
|
Facility
|
IP
|
$3,817.00
|
|
|
Service Code
|
HCPCS 38222
|
| Hospital Charge Code |
761T1590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.10 |
| Max. Negotiated Rate |
$3,664.32 |
| Rate for Payer: Aetna Commercial |
$2,939.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,977.26
|
| Rate for Payer: Cash Price |
$1,908.50
|
| Rate for Payer: Cigna Commercial |
$3,168.11
|
| Rate for Payer: First Health Commercial |
$3,626.15
|
| Rate for Payer: Humana Commercial |
$3,244.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,129.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,816.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,145.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,358.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,862.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,320.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.73
|
| Rate for Payer: PHCS Commercial |
$3,664.32
|
| Rate for Payer: United Healthcare All Payer |
$3,358.96
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Ambetter Exchange |
$175.95
|
| Rate for Payer: Anthem Medicaid |
$147.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$175.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$211.14
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$313.90
|
| Rate for Payer: Healthspan PPO |
$173.39
|
| Rate for Payer: Humana Medicaid |
$147.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$175.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.49
|
| Rate for Payer: Molina Healthcare Passport |
$147.54
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$228.74
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$175.95
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$6,060.60 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem Medicaid |
$77.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,329.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,060.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,844.15
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Humana KY Medicaid |
$77.38
|
| Rate for Payer: Humana Medicare Advantage |
$4,329.00
|
| Rate for Payer: Kentucky WC Medicaid |
$78.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,194.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
BONE MARROW HARVEST AUTOLOG
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 38232
|
| Hospital Charge Code |
76102793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS
|
Facility
|
OP
|
$6,060.60
|
|
|
Service Code
|
CPT 38232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,329.00 |
| Max. Negotiated Rate |
$6,060.60 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,329.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,060.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,844.15
|
| Rate for Payer: Humana Medicare Advantage |
$4,329.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,194.80
|
|
|
BONE MATRIX CELLULAR 1.0
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
BONE MATRIX CELLULAR 1.0
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
