|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
OP
|
$4.62
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
636T0194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
COMPAZINE(PROCHLOR)10 10MG/2ML
|
Facility
|
IP
|
$4.62
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.39
|
| Rate for Payer: Humana Commercial |
$3.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
COMPAZINE(PROCHLORPE 10MG/1TAB
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
25000451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.92
|
| Rate for Payer: First Health Commercial |
$4.48
|
| Rate for Payer: Humana Commercial |
$4.01
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.15
|
| Rate for Payer: Ohio Health Group HMO |
$3.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Payer |
$4.15
|
|
|
COMPAZINE(PROCHLORPE 10MG/1TAB
|
Facility
|
IP
|
$4.72
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
25000451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.68
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna Commercial |
$3.92
|
| Rate for Payer: First Health Commercial |
$4.48
|
| Rate for Payer: Humana Commercial |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.15
|
| Rate for Payer: Ohio Health Group HMO |
$3.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.53
|
| Rate for Payer: United Healthcare All Payer |
$4.15
|
|
|
COMPAZINE(PROCHLORPER 25MG/1EA
|
Facility
|
OP
|
$25.71
|
|
|
Service Code
|
NDC 574722612
|
| Hospital Charge Code |
25000452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Anthem Medicaid |
$8.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.05
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: Cigna Commercial |
$21.34
|
| Rate for Payer: First Health Commercial |
$24.42
|
| Rate for Payer: Humana Commercial |
$21.85
|
| Rate for Payer: Humana KY Medicaid |
$8.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.62
|
| Rate for Payer: Ohio Health Group HMO |
$19.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.97
|
| Rate for Payer: PHCS Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Payer |
$22.62
|
|
|
COMPAZINE(PROCHLORPER 25MG/1EA
|
Facility
|
IP
|
$25.71
|
|
|
Service Code
|
NDC 574722612
|
| Hospital Charge Code |
25000452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.05
|
| Rate for Payer: Cash Price |
$12.86
|
| Rate for Payer: Cigna Commercial |
$21.34
|
| Rate for Payer: First Health Commercial |
$24.42
|
| Rate for Payer: Humana Commercial |
$21.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.62
|
| Rate for Payer: Ohio Health Group HMO |
$19.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.97
|
| Rate for Payer: PHCS Commercial |
$24.68
|
| Rate for Payer: United Healthcare All Payer |
$22.62
|
|
|
COMPAZINE(PROCHLORPER 5MG/1TAB
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
25002706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.32
|
| Rate for Payer: Humana Commercial |
$3.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
COMPAZINE(PROCHLORPER 5MG/1TAB
|
Facility
|
OP
|
$4.55
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
25002706
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cigna Commercial |
$3.78
|
| Rate for Payer: First Health Commercial |
$4.32
|
| Rate for Payer: Humana Commercial |
$3.87
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.37
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
COMPLETE SKELETAL BONE SURVE(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
320P0236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$151.21 |
| Rate for Payer: Aetna Commercial |
$151.21
|
| Rate for Payer: Anthem Medicaid |
$62.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$131.65
|
| Rate for Payer: Healthspan PPO |
$141.69
|
| Rate for Payer: Humana Medicaid |
$62.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.99
|
| Rate for Payer: Molina Healthcare Passport |
$62.74
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.37
|
|
|
COMPLETE SKELETAL BONE SURVE(T
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
320T0236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
COMPLETE SKELETAL BONE SURVE(T
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
320T0236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem Medicaid |
$218.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Humana KY Medicaid |
$218.38
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
COMPLETE SKELETAL BONE SURVEY
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$681.60 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.10
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
COMPLETE SKELETAL BONE SURVEY
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.30 |
| Max. Negotiated Rate |
$681.60 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem Medicaid |
$244.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Humana KY Medicaid |
$244.17
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$246.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.10
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
COMPLETE SKELETAL BONE SURVEY
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 77075
|
| Hospital Charge Code |
32000236
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$710.00 |
| Rate for Payer: Aetna Commercial |
$151.21
|
| Rate for Payer: Anthem Medicaid |
$62.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$131.65
|
| Rate for Payer: Healthspan PPO |
$141.69
|
| Rate for Payer: Humana Medicaid |
$62.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.99
|
| Rate for Payer: Molina Healthcare Passport |
$62.74
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.00
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.37
|
|
|
COMPLEX CYSTOMETROGRAM
|
Professional
|
Both
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$1,744.00 |
| Rate for Payer: Aetna Commercial |
$493.13
|
| Rate for Payer: Anthem Medicaid |
$87.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,744.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$394.30
|
| Rate for Payer: Humana Medicaid |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.70
|
| Rate for Payer: Molina Healthcare Passport |
$87.94
|
| Rate for Payer: Multiplan PHCS |
$1,046.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,220.80
|
| Rate for Payer: UHCCP Medicaid |
$610.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.82
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$226.72 |
| Max. Negotiated Rate |
$1,674.24 |
| Rate for Payer: Aetna Commercial |
$1,342.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.32
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,447.52
|
| Rate for Payer: First Health Commercial |
$1,656.80
|
| Rate for Payer: Humana Commercial |
$1,482.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.64
|
| Rate for Payer: PHCS Commercial |
$1,674.24
|
| Rate for Payer: United Healthcare All Payer |
$1,534.72
|
|
|
COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$1,744.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
32000262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$213.72 |
| Max. Negotiated Rate |
$1,674.24 |
| Rate for Payer: Aetna Commercial |
$1,342.88
|
| Rate for Payer: Anthem Medicaid |
$599.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cigna Commercial |
$1,447.52
|
| Rate for Payer: First Health Commercial |
$1,656.80
|
| Rate for Payer: Humana Commercial |
$1,482.40
|
| Rate for Payer: Humana KY Medicaid |
$599.76
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$605.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.64
|
| Rate for Payer: PHCS Commercial |
$1,674.24
|
| Rate for Payer: United Healthcare All Payer |
$1,534.72
|
|
|
COMPLEX CYSTOMETROGRAM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320P0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$493.13
|
| Rate for Payer: Anthem Medicaid |
$87.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$394.30
|
| Rate for Payer: Humana Medicaid |
$87.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.70
|
| Rate for Payer: Molina Healthcare Passport |
$87.94
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.82
|
|
|
COMPLEX CYSTOMETROGRAM(T
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320T0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$148.72 |
| Max. Negotiated Rate |
$1,098.24 |
| Rate for Payer: Aetna Commercial |
$880.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.32
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$949.52
|
| Rate for Payer: First Health Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial |
$972.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,006.72
|
| Rate for Payer: Ohio Health Group HMO |
$858.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.64
|
| Rate for Payer: PHCS Commercial |
$1,098.24
|
| Rate for Payer: United Healthcare All Payer |
$1,006.72
|
|
|
COMPLEX CYSTOMETROGRAM(T
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
HCPCS 51726
|
| Hospital Charge Code |
320T0262
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$148.72 |
| Max. Negotiated Rate |
$1,098.24 |
| Rate for Payer: Aetna Commercial |
$880.88
|
| Rate for Payer: Anthem Medicaid |
$393.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cash Price |
$572.00
|
| Rate for Payer: Cigna Commercial |
$949.52
|
| Rate for Payer: First Health Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial |
$972.40
|
| Rate for Payer: Humana KY Medicaid |
$393.42
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$397.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$401.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,006.72
|
| Rate for Payer: Ohio Health Group HMO |
$858.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.64
|
| Rate for Payer: PHCS Commercial |
$1,098.24
|
| Rate for Payer: United Healthcare All Payer |
$1,006.72
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
IP
|
$3,612.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.56 |
| Max. Negotiated Rate |
$3,467.52 |
| Rate for Payer: Aetna Commercial |
$2,781.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.36
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$2,997.96
|
| Rate for Payer: First Health Commercial |
$3,431.40
|
| Rate for Payer: Humana Commercial |
$3,070.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,665.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,178.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$722.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.72
|
| Rate for Payer: PHCS Commercial |
$3,467.52
|
| Rate for Payer: United Healthcare All Payer |
$3,178.56
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
IP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
76100016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.56 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.72
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
OP
|
$3,612.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
45000026
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$469.56 |
| Max. Negotiated Rate |
$3,467.52 |
| Rate for Payer: Aetna Commercial |
$2,781.24
|
| Rate for Payer: Anthem Medicaid |
$1,242.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,817.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$2,997.96
|
| Rate for Payer: First Health Commercial |
$3,431.40
|
| Rate for Payer: Humana Commercial |
$3,070.20
|
| Rate for Payer: Humana KY Medicaid |
$1,242.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,665.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,267.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,178.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,709.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$722.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.72
|
| Rate for Payer: PHCS Commercial |
$3,467.52
|
| Rate for Payer: United Healthcare All Payer |
$3,178.56
|
|
|
COMPLEX DRAINAGE - WOUND
|
Facility
|
OP
|
$4,112.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
76100016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.56 |
| Max. Negotiated Rate |
$3,947.52 |
| Rate for Payer: Aetna Commercial |
$3,166.24
|
| Rate for Payer: Anthem Medicaid |
$1,414.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cash Price |
$2,056.00
|
| Rate for Payer: Cigna Commercial |
$3,412.96
|
| Rate for Payer: First Health Commercial |
$3,906.40
|
| Rate for Payer: Humana Commercial |
$3,495.20
|
| Rate for Payer: Humana KY Medicaid |
$1,414.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,428.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,442.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.72
|
| Rate for Payer: PHCS Commercial |
$3,947.52
|
| Rate for Payer: United Healthcare All Payer |
$3,618.56
|
|
