|
FLUORESCITE 10% 5 ML 500MG/5ML
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
NDC 17478025310
|
| Hospital Charge Code |
25003072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$327.36 |
| Rate for Payer: Aetna Commercial |
$262.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.98
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cigna Commercial |
$283.03
|
| Rate for Payer: First Health Commercial |
$323.95
|
| Rate for Payer: Humana Commercial |
$289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$300.08
|
| Rate for Payer: Ohio Health Group HMO |
$255.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.71
|
| Rate for Payer: PHCS Commercial |
$327.36
|
| Rate for Payer: United Healthcare All Payer |
$300.08
|
|
|
FLUOR I STRIP 300 (EACH ST 1EA
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
25000694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
FLUOR I STRIP 300 (EACH ST 1EA
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 17238090011
|
| Hospital Charge Code |
25000694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.37
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem Medicaid |
$274.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Humana KY Medicaid |
$274.78
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$277.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.00
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.33
|
| Rate for Payer: Molina Healthcare Passport |
$25.81
|
| Rate for Payer: Multiplan PHCS |
$479.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.30
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.07
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
32001017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$799.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.00
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.33
|
| Rate for Payer: Molina Healthcare Passport |
$25.81
|
| Rate for Payer: Multiplan PHCS |
$479.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$559.30
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.07
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem Medicaid |
$274.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Humana KY Medicaid |
$274.78
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$277.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
FLUORO EXAM OF G/COLON TUBE
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
76102011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$767.04 |
| Rate for Payer: Aetna Commercial |
$615.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$623.22
|
| Rate for Payer: Cash Price |
$399.50
|
| Rate for Payer: Cigna Commercial |
$663.17
|
| Rate for Payer: First Health Commercial |
$759.05
|
| Rate for Payer: Humana Commercial |
$679.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$655.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$589.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$703.12
|
| Rate for Payer: Ohio Health Group HMO |
$599.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$247.69
|
| Rate for Payer: PHCS Commercial |
$767.04
|
| Rate for Payer: United Healthcare All Payer |
$703.12
|
|
|
FLUORO EXAM OF G/COLON TUBE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761P2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.33
|
| Rate for Payer: Molina Healthcare Passport |
$25.81
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.07
|
|
|
FLUORO EXAM OF G/COLON TUBE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320P1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.55
|
| Rate for Payer: Anthem Medicaid |
$25.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$46.29
|
| Rate for Payer: Healthspan PPO |
$206.66
|
| Rate for Payer: Humana Medicaid |
$25.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.33
|
| Rate for Payer: Molina Healthcare Passport |
$25.81
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$29.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.07
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320T1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$307.23
|
| Rate for Payer: Anthem Medicaid |
$137.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$331.17
|
| Rate for Payer: First Health Commercial |
$379.05
|
| Rate for Payer: Humana Commercial |
$339.15
|
| Rate for Payer: Humana KY Medicaid |
$137.22
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$138.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$327.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$351.12
|
| Rate for Payer: Ohio Health Group HMO |
$299.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.69
|
| Rate for Payer: PHCS Commercial |
$383.04
|
| Rate for Payer: United Healthcare All Payer |
$351.12
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
320T1017
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$307.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.22
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$331.17
|
| Rate for Payer: First Health Commercial |
$379.05
|
| Rate for Payer: Humana Commercial |
$339.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$327.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$351.12
|
| Rate for Payer: Ohio Health Group HMO |
$299.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.69
|
| Rate for Payer: PHCS Commercial |
$383.04
|
| Rate for Payer: United Healthcare All Payer |
$351.12
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761T2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$307.23
|
| Rate for Payer: Anthem Medicaid |
$137.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$331.17
|
| Rate for Payer: First Health Commercial |
$379.05
|
| Rate for Payer: Humana Commercial |
$339.15
|
| Rate for Payer: Humana KY Medicaid |
$137.22
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$138.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$327.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$351.12
|
| Rate for Payer: Ohio Health Group HMO |
$299.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.69
|
| Rate for Payer: PHCS Commercial |
$383.04
|
| Rate for Payer: United Healthcare All Payer |
$351.12
|
|
|
FLUORO EXAM OF G/COLON TUBE(T
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
761T2011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$307.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$311.22
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$331.17
|
| Rate for Payer: First Health Commercial |
$379.05
|
| Rate for Payer: Humana Commercial |
$339.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$327.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$294.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$351.12
|
| Rate for Payer: Ohio Health Group HMO |
$299.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.69
|
| Rate for Payer: PHCS Commercial |
$383.04
|
| Rate for Payer: United Healthcare All Payer |
$351.12
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Humana KY Medicaid |
$285.44
|
| Rate for Payer: Kentucky WC Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
FLUORO GUIDANCE NEEDLE PLACE
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32000223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.88
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Humana KY Medicaid |
$285.44
|
| Rate for Payer: Kentucky WC Medicaid |
$288.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.88
|
|
|
FLUORO GUIDANCE NEEDLE PLACEME
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
32001013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$796.80 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$688.90
|
| Rate for Payer: First Health Commercial |
$788.50
|
| Rate for Payer: Humana Commercial |
$705.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
| Rate for Payer: Ohio Health Group HMO |
$622.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
FLUORO GUIDANCE NEEDLE PLACE(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320P0223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$111.23 |
| Rate for Payer: Aetna Commercial |
$108.76
|
| Rate for Payer: Anthem Medicaid |
$53.35
|
| 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 |
$111.23
|
| Rate for Payer: Healthspan PPO |
$101.91
|
| Rate for Payer: Humana Medicaid |
$53.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.42
|
| Rate for Payer: Molina Healthcare Passport |
$53.35
|
| 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 |
$53.88
|
|
|
FLUORO GUIDANCE NEEDLE PLACE(T
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T0223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
FLUORO GUIDANCE NEEDLE PLACE(T
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T0223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.05
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
FLUOROGUIDE FOR SPINE INJEC(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320P0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$108.13 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem Medicaid |
$52.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$108.13
|
| Rate for Payer: Healthspan PPO |
$86.26
|
| Rate for Payer: Humana Medicaid |
$52.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.34
|
| Rate for Payer: Molina Healthcare Passport |
$52.29
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.81
|
|
