|
BOTOX COSM 1 UNIT (50U VL)
|
Professional
|
Both
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600016
|
|
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
|
OP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0016
|
|
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 COSM 1 UNIT (50U VL)
|
Facility
|
IP
|
$12.68
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
636T0016
|
|
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
|
IP
|
$1,972.90
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$591.87 |
| Max. Negotiated Rate |
$1,893.98 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.86
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cigna Commercial |
$1,637.51
|
| Rate for Payer: First Health Commercial |
$1,874.26
|
| Rate for Payer: Humana Commercial |
$1,676.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,716.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.30
|
| Rate for Payer: PHCS Commercial |
$1,893.98
|
| Rate for Payer: United Healthcare All Payer |
$1,736.15
|
|
|
BOTOX COSM 1 UNIT (50U VL)
|
Facility
|
OP
|
$1,972.90
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
25001901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$1,893.98 |
| Rate for Payer: Aetna Commercial |
$1,519.13
|
| Rate for Payer: Anthem Medicaid |
$678.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.78
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cash Price |
$986.45
|
| Rate for Payer: Cigna Commercial |
$1,637.51
|
| Rate for Payer: First Health Commercial |
$1,874.26
|
| Rate for Payer: Humana Commercial |
$1,676.96
|
| Rate for Payer: Humana KY Medicaid |
$678.48
|
| Rate for Payer: Humana Medicare Advantage |
$6.50
|
| Rate for Payer: Kentucky WC Medicaid |
$685.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,716.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.30
|
| Rate for Payer: PHCS Commercial |
$1,893.98
|
| Rate for Payer: United Healthcare All Payer |
$1,736.15
|
|
|
BOWEL TO BOWEL FUSION
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 44130
|
| Hospital Charge Code |
76102610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,820.23 |
| Rate for Payer: Aetna Commercial |
$1,820.23
|
| Rate for Payer: Ambetter Exchange |
$1,253.53
|
| Rate for Payer: Anthem Medicaid |
$603.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,253.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,253.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,504.24
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,641.02
|
| Rate for Payer: Healthspan PPO |
$1,535.03
|
| Rate for Payer: Humana Medicaid |
$603.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,663.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,253.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$615.22
|
| Rate for Payer: Molina Healthcare Passport |
$603.16
|
| Rate for Payer: Multiplan PHCS |
$933.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,629.59
|
| Rate for Payer: UHCCP Medicaid |
$544.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$609.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,253.53
|
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
HCPCS 44130
|
| Hospital Charge Code |
76102610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,493.76 |
| Rate for Payer: Aetna Commercial |
$1,198.12
|
| Rate for Payer: Anthem Medicaid |
$535.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,291.48
|
| Rate for Payer: First Health Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial |
$1,322.60
|
| Rate for Payer: Humana KY Medicaid |
$535.11
|
| Rate for Payer: Kentucky WC Medicaid |
$540.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.64
|
| Rate for Payer: PHCS Commercial |
$1,493.76
|
| Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
|
BOWEL TO BOWEL FUSION
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
HCPCS 44130
|
| Hospital Charge Code |
76102610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$466.80 |
| Max. Negotiated Rate |
$1,493.76 |
| Rate for Payer: Aetna Commercial |
$1,198.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,291.48
|
| Rate for Payer: First Health Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial |
$1,322.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.64
|
| Rate for Payer: PHCS Commercial |
$1,493.76
|
| Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
|
BOWEL TO BOWEL FUSION
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 44130
|
| Hospital Charge Code |
761P2610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,820.23 |
| Rate for Payer: Aetna Commercial |
$1,820.23
|
| Rate for Payer: Ambetter Exchange |
$1,253.53
|
| Rate for Payer: Anthem Medicaid |
$603.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,253.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,253.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,504.24
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,641.02
|
| Rate for Payer: Healthspan PPO |
$1,535.03
|
| Rate for Payer: Humana Medicaid |
$603.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,663.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,253.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$615.22
|
| Rate for Payer: Molina Healthcare Passport |
$603.16
|
| Rate for Payer: Multiplan PHCS |
$933.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,629.59
|
| Rate for Payer: UHCCP Medicaid |
$544.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$609.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,253.53
|
|
|
BPH INITIAL TREATMENT
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
41000082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
BPH INITIAL TREATMENT
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
41000082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: Ambetter Exchange |
$22.47
|
| Rate for Payer: Anthem Medicaid |
$15.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.96
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$32.05
|
| Rate for Payer: Healthspan PPO |
$24.32
|
| Rate for Payer: Humana Medicaid |
$15.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.29
|
| Rate for Payer: Molina Healthcare Passport |
$15.97
|
| Rate for Payer: Multiplan PHCS |
$160.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$93.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.47
|
|
|
BPH INITIAL TREATMENT
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
41000082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Humana KY Medicaid |
$91.82
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
BPH INITIAL TREATMENT(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
410P0082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: Ambetter Exchange |
$22.47
|
| Rate for Payer: Anthem Medicaid |
$15.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$26.96
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$32.05
|
| Rate for Payer: Healthspan PPO |
$24.32
|
| Rate for Payer: Humana Medicaid |
$15.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.29
|
| Rate for Payer: Molina Healthcare Passport |
$15.97
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.21
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.47
|
|
|
BPH INITIAL TREATMENT(T
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
410T0082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
BPH INITIAL TREATMENT(T
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 94667
|
| Hospital Charge Code |
410T0082
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
BPH SUBSEQUENT
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
41000083
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
BPH SUBSEQUENT
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
HCPCS 94668
|
| Hospital Charge Code |
41000083
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$179.52 |
| Rate for Payer: Aetna Commercial |
$143.99
|
| Rate for Payer: Anthem Medicaid |
$64.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$145.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$155.21
|
| Rate for Payer: First Health Commercial |
$177.65
|
| Rate for Payer: Humana Commercial |
$158.95
|
| Rate for Payer: Humana KY Medicaid |
$64.31
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$64.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$164.56
|
| Rate for Payer: Ohio Health Group HMO |
$140.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.03
|
| Rate for Payer: PHCS Commercial |
$179.52
|
| Rate for Payer: United Healthcare All Payer |
$164.56
|
|
|
BRACHIOPLASTY
|
Facility
|
IP
|
$1,245.00
|
|
| Hospital Charge Code |
22200037
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
BRACHIOPLASTY
|
Facility
|
OP
|
$1,245.00
|
|
| Hospital Charge Code |
22200037
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
BRACHIOPLASTY
|
Professional
|
Both
|
$1,245.00
|
|
| Hospital Charge Code |
22200037
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$871.50 |
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
|
|
BRACHIOPLASTY -80
|
Professional
|
Both
|
$622.50
|
|
| Hospital Charge Code |
22200373
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$217.88 |
| Max. Negotiated Rate |
$435.75 |
| Rate for Payer: Cash Price |
$311.25
|
| Rate for Payer: Multiplan PHCS |
$373.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.75
|
| Rate for Payer: UHCCP Medicaid |
$217.88
|
|
|
BRACHIOPLASTY -80
|
Facility
|
OP
|
$622.50
|
|
| Hospital Charge Code |
22200373
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$597.60 |
| Rate for Payer: Aetna Commercial |
$479.32
|
| Rate for Payer: Anthem Medicaid |
$214.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.55
|
| Rate for Payer: Cash Price |
$311.25
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: First Health Commercial |
$591.38
|
| Rate for Payer: Humana Commercial |
$529.12
|
| Rate for Payer: Humana KY Medicaid |
$214.08
|
| Rate for Payer: Kentucky WC Medicaid |
$216.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.80
|
| Rate for Payer: Ohio Health Group HMO |
$466.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.52
|
| Rate for Payer: PHCS Commercial |
$597.60
|
| Rate for Payer: United Healthcare All Payer |
$547.80
|
|
|
BRACHIOPLASTY -80
|
Facility
|
IP
|
$622.50
|
|
| Hospital Charge Code |
22200373
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$597.60 |
| Rate for Payer: Aetna Commercial |
$479.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.55
|
| Rate for Payer: Cash Price |
$311.25
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: First Health Commercial |
$591.38
|
| Rate for Payer: Humana Commercial |
$529.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.80
|
| Rate for Payer: Ohio Health Group HMO |
$466.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$498.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.52
|
| Rate for Payer: PHCS Commercial |
$597.60
|
| Rate for Payer: United Healthcare All Payer |
$547.80
|
|
|
BRACHY INTERMEDIATE
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77317
|
| Hospital Charge Code |
33300011
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Ambetter Exchange |
$294.23
|
| Rate for Payer: Anthem Medicaid |
$183.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$294.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$294.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$353.08
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$382.91
|
| Rate for Payer: Humana Medicaid |
$183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$294.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$187.03
|
| Rate for Payer: Molina Healthcare Passport |
$183.36
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$382.50
|
| Rate for Payer: UHCCP Medicaid |
$396.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$185.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$294.23
|
|
|
BRACHY INTERMEDIATE
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77317
|
| Hospital Charge Code |
33300011
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Humana KY Medicaid |
$389.98
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$393.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
