|
FLUOROGUIDE FOR SPINE INJEC(T
|
Facility
|
IP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320T0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
FLUOROGUIDE FOR SPINE INJEC(T
|
Facility
|
OP
|
$1,074.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
320T0224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.62 |
| Max. Negotiated Rate |
$1,031.04 |
| Rate for Payer: Aetna Commercial |
$826.98
|
| Rate for Payer: Anthem Medicaid |
$369.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$837.72
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$891.42
|
| Rate for Payer: First Health Commercial |
$1,020.30
|
| Rate for Payer: Humana Commercial |
$912.90
|
| Rate for Payer: Humana KY Medicaid |
$369.35
|
| Rate for Payer: Kentucky WC Medicaid |
$373.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$880.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$792.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$945.12
|
| Rate for Payer: Ohio Health Group HMO |
$805.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.94
|
| Rate for Payer: PHCS Commercial |
$1,031.04
|
| Rate for Payer: United Healthcare All Payer |
$945.12
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| 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: 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 |
$340.20
|
| 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 |
$226.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| 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: 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 |
$340.20
|
| 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 |
$226.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
FLUOROGUIDE FOR SPINE INJECT
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 77003
|
| Hospital Charge Code |
32000224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$92.06
|
| Rate for Payer: Anthem Medicaid |
$52.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,134.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| 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 |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.80
|
| Rate for Payer: UHCCP Medicaid |
$396.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.81
|
|
|
FLUORO GUIDE NEEDLE PLACE (P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320P1013
|
|
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 GUIDE NEEDLE PLACE (T
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T1013
|
|
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 GUIDE NEEDLE PLACE (T
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
320T1013
|
|
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
|
|
|
FLUOROMETHALINE 0.1% OPTH SUSP
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60758088010
|
| Hospital Charge Code |
25000695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem Medicaid |
$0.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Humana KY Medicaid |
$0.98
|
| Rate for Payer: Kentucky WC Medicaid |
$0.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.89
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
FLUOROMETHALINE 0.1% OPTH SUSP
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60758088010
|
| Hospital Charge Code |
25000695
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.23
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Cigna Commercial |
$2.37
|
| Rate for Payer: First Health Commercial |
$2.72
|
| Rate for Payer: Humana Commercial |
$2.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.52
|
| Rate for Payer: Ohio Health Group HMO |
$2.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.89
|
| Rate for Payer: PHCS Commercial |
$2.75
|
| Rate for Payer: United Healthcare All Payer |
$2.52
|
|
|
FLUOROMETHOLONE 0.1%EYESUSP5ML
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
25003073
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna Commercial |
$2.59
|
| Rate for Payer: First Health Commercial |
$2.96
|
| Rate for Payer: Humana Commercial |
$2.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.75
|
| Rate for Payer: Ohio Health Group HMO |
$2.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.97
|
| Rate for Payer: PHCS Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Payer |
$2.75
|
|
|
FLUOROMETHOLONE 0.1%EYESUSP5ML
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 60758088005
|
| Hospital Charge Code |
25003073
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Anthem Medicaid |
$1.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.43
|
| Rate for Payer: Cash Price |
$1.56
|
| Rate for Payer: Cigna Commercial |
$2.59
|
| Rate for Payer: First Health Commercial |
$2.96
|
| Rate for Payer: Humana Commercial |
$2.65
|
| Rate for Payer: Humana KY Medicaid |
$1.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2.75
|
| Rate for Payer: Ohio Health Group HMO |
$2.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.97
|
| Rate for Payer: PHCS Commercial |
$3.00
|
| Rate for Payer: United Healthcare All Payer |
$2.75
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem Medicaid |
$242.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Humana KY Medicaid |
$242.11
|
| Rate for Payer: Kentucky WC Medicaid |
$244.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$246.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
FLUOROSCOPIC GUIDANCE
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$924.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$554.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$646.80
|
| Rate for Payer: UHCCP Medicaid |
$323.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
FLUOROSCOPIC GUIDANCE
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$924.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$554.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$646.80
|
| Rate for Payer: UHCCP Medicaid |
$323.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
76102444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem Medicaid |
$317.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Humana KY Medicaid |
$317.76
|
| Rate for Payer: Kentucky WC Medicaid |
$321.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
32000222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.12 |
| Max. Negotiated Rate |
$887.04 |
| Rate for Payer: Aetna Commercial |
$711.48
|
| Rate for Payer: Anthem Medicaid |
$317.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$720.72
|
| Rate for Payer: Cash Price |
$462.00
|
| Rate for Payer: Cigna Commercial |
$766.92
|
| Rate for Payer: First Health Commercial |
$877.80
|
| Rate for Payer: Humana Commercial |
$785.40
|
| Rate for Payer: Humana KY Medicaid |
$317.76
|
| Rate for Payer: Kentucky WC Medicaid |
$321.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$757.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$681.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$813.12
|
| Rate for Payer: Ohio Health Group HMO |
$693.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.44
|
| Rate for Payer: PHCS Commercial |
$887.04
|
| Rate for Payer: United Healthcare All Payer |
$813.12
|
|
|
FLUOROSCOPIC GUIDANCE(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761P2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
|
|
FLUOROSCOPIC GUIDANCE(T
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761T2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
FLUOROSCOPIC GUIDANCE(T
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
761T2444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem Medicaid |
$242.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Humana KY Medicaid |
$242.11
|
| Rate for Payer: Kentucky WC Medicaid |
$244.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$246.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
FLUOROSCOPY
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem Medicaid |
$264.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Humana KY Medicaid |
$264.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
|
FLUOROSCOPY
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
HCPCS 76000
|
| Hospital Charge Code |
32000181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$737.28 |
| Rate for Payer: Aetna Commercial |
$591.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.04
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$637.44
|
| Rate for Payer: First Health Commercial |
$729.60
|
| Rate for Payer: Humana Commercial |
$652.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$629.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$566.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$675.84
|
| Rate for Payer: Ohio Health Group HMO |
$576.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.08
|
| Rate for Payer: PHCS Commercial |
$737.28
|
| Rate for Payer: United Healthcare All Payer |
$675.84
|
|
