|
BONE MINERAL DENSITY TESTING
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Ambetter Exchange |
$35.43
|
| Rate for Payer: Anthem Medicaid |
$76.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.52
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$163.64
|
| Rate for Payer: Healthspan PPO |
$103.56
|
| Rate for Payer: Humana Medicaid |
$76.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.57
|
| Rate for Payer: Molina Healthcare Passport |
$76.05
|
| Rate for Payer: Multiplan PHCS |
$356.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.06
|
| Rate for Payer: UHCCP Medicaid |
$207.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.43
|
|
|
BONE MINERAL DENSITY TESTING
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$570.24 |
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
|
|
BONE MINERAL DENSITY TESTING
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
32000237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$570.24 |
| Rate for Payer: Aetna Commercial |
$457.38
|
| Rate for Payer: Anthem Medicaid |
$204.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$463.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna Commercial |
$493.02
|
| Rate for Payer: First Health Commercial |
$564.30
|
| Rate for Payer: Humana Commercial |
$504.90
|
| Rate for Payer: Humana KY Medicaid |
$204.28
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$206.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$438.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$522.72
|
| Rate for Payer: Ohio Health Group HMO |
$445.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.86
|
| Rate for Payer: PHCS Commercial |
$570.24
|
| Rate for Payer: United Healthcare All Payer |
$522.72
|
|
|
BONE MINERAL DENSITY TESTING(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320P0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$163.64 |
| Rate for Payer: Aetna Commercial |
$110.52
|
| Rate for Payer: Ambetter Exchange |
$35.43
|
| Rate for Payer: Anthem Medicaid |
$76.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.52
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$163.64
|
| Rate for Payer: Healthspan PPO |
$103.56
|
| Rate for Payer: Humana Medicaid |
$76.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.57
|
| Rate for Payer: Molina Healthcare Passport |
$76.05
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.06
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.43
|
|
|
BONE MINERAL DENSITY TESTING(T
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320T0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
BONE MINERAL DENSITY TESTING(T
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS 77080
|
| Hospital Charge Code |
320T0237
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
BONE MINERAL VERTEBRAL FX
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$473.40 |
| Rate for Payer: Ambetter Exchange |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$41.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.46
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$88.09
|
| Rate for Payer: Humana Medicaid |
$41.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.81
|
| Rate for Payer: Molina Healthcare Passport |
$41.97
|
| Rate for Payer: Multiplan PHCS |
$473.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.34
|
| Rate for Payer: UHCCP Medicaid |
$276.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.72
|
|
|
BONE MINERAL VERTEBRAL FX
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem Medicaid |
$271.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Humana KY Medicaid |
$271.34
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$274.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
BONE MINERAL VERTEBRAL FX
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
32000238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.70 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
BONE MINERAL VERTEBRAL FX(P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320P0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$88.09 |
| Rate for Payer: Ambetter Exchange |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$41.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$48.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$48.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.46
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$88.09
|
| Rate for Payer: Humana Medicaid |
$41.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$48.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.81
|
| Rate for Payer: Molina Healthcare Passport |
$41.97
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.34
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$48.72
|
|
|
BONE MINERAL VERTEBRAL FX(T
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320T0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
BONE MINERAL VERTEBRAL FX(T
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 77085
|
| Hospital Charge Code |
320T0238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
BONE VIBRATOR HEARING AID
|
Facility
|
IP
|
$1,500.00
|
|
| Hospital Charge Code |
47000045
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
BONE VIBRATOR HEARING AID
|
Facility
|
OP
|
$1,500.00
|
|
| Hospital Charge Code |
47000045
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
BONIVA 1MG (3MG/3ML KIT) SYR
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
25002158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.90 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem Medicaid |
$231.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Humana KY Medicaid |
$231.44
|
| Rate for Payer: Kentucky WC Medicaid |
$233.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
BONIVA 1MG (3MG/3ML KIT) SYR
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
25002158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.90 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.78
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.78
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
IP
|
$3,520.70
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,056.21 |
| Max. Negotiated Rate |
$3,379.87 |
| Rate for Payer: Aetna Commercial |
$2,710.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.15
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cigna Commercial |
$2,922.18
|
| Rate for Payer: First Health Commercial |
$3,344.66
|
| Rate for Payer: Humana Commercial |
$2,992.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,816.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.28
|
| Rate for Payer: PHCS Commercial |
$3,379.87
|
| Rate for Payer: United Healthcare All Payer |
$3,098.22
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Facility
|
OP
|
$3,520.70
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001904
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$3,379.87 |
| Rate for Payer: Aetna Commercial |
$2,710.94
|
| Rate for Payer: Anthem Medicaid |
$1,210.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.78
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cash Price |
$1,760.35
|
| Rate for Payer: Cigna Commercial |
$2,922.18
|
| Rate for Payer: First Health Commercial |
$3,344.66
|
| Rate for Payer: Humana Commercial |
$2,992.59
|
| Rate for Payer: Humana KY Medicaid |
$1,210.77
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,816.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.28
|
| Rate for Payer: PHCS Commercial |
$3,379.87
|
| Rate for Payer: United Healthcare All Payer |
$3,098.22
|
|
|
BOTOX 1UNIT (100 UNIT VIAL)
|
Professional
|
Both
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$8.59 |
| Rate for Payer: Aetna Commercial |
$8.33
|
| Rate for Payer: Ambetter Exchange |
$6.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.80
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Healthspan PPO |
$7.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$8.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.50
|
| Rate for Payer: Multiplan PHCS |
$7.61
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.45
|
| Rate for Payer: UHCCP Medicaid |
$4.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.50
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$12.17 |
| Rate for Payer: Aetna Commercial |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$4.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.78
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: First Health Commercial |
$12.05
|
| Rate for Payer: Humana Commercial |
$10.78
|
| Rate for Payer: Humana KY Medicaid |
$4.36
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.16
|
| Rate for Payer: Ohio Health Group HMO |
$9.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.75
|
| Rate for Payer: PHCS Commercial |
$12.17
|
| Rate for Payer: United Healthcare All Payer |
$11.16
|
|
