|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
25000224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.92
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.17
|
| Rate for Payer: First Health Commercial |
$4.78
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.43
|
| Rate for Payer: Ohio Health Group HMO |
$3.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.83
|
| Rate for Payer: United Healthcare All Payer |
$4.43
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
|
IP
|
$15,224.05
|
|
|
Service Code
|
MSDRG 348
|
| Min. Negotiated Rate |
$10,330.60 |
| Max. Negotiated Rate |
$15,224.05 |
| Rate for Payer: Anthem Medicaid |
$10,330.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,874.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,224.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,680.33
|
| Rate for Payer: Humana KY Medicaid |
$10,330.60
|
| Rate for Payer: Humana Medicare Advantage |
$10,874.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10,433.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,049.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,537.22
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$29,819.89
|
|
|
Service Code
|
MSDRG 347
|
| Min. Negotiated Rate |
$20,234.92 |
| Max. Negotiated Rate |
$29,819.89 |
| Rate for Payer: Anthem Medicaid |
$20,234.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$21,299.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,819.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$28,754.89
|
| Rate for Payer: Humana KY Medicaid |
$20,234.92
|
| Rate for Payer: Humana Medicare Advantage |
$21,299.92
|
| Rate for Payer: Kentucky WC Medicaid |
$20,437.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,559.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,639.62
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,415.10
|
|
|
Service Code
|
MSDRG 349
|
| Min. Negotiated Rate |
$7,745.96 |
| Max. Negotiated Rate |
$11,415.10 |
| Rate for Payer: Anthem Medicaid |
$7,745.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,153.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,415.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,007.41
|
| Rate for Payer: Humana KY Medicaid |
$7,745.96
|
| Rate for Payer: Humana Medicare Advantage |
$8,153.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,823.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,784.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,900.88
|
|
|
ANALPRAM HC 2.5% CREAM 4 GRAM
|
Facility
|
OP
|
$24.53
|
|
|
Service Code
|
NDC 45802047265
|
| Hospital Charge Code |
25000225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem Medicaid |
$8.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Humana KY Medicaid |
$8.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
ANALPRAM HC 2.5% CREAM 4 GRAM
|
Facility
|
IP
|
$24.53
|
|
|
Service Code
|
NDC 45802047265
|
| Hospital Charge Code |
25000225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.13
|
| Rate for Payer: Cash Price |
$12.27
|
| Rate for Payer: Cigna Commercial |
$20.36
|
| Rate for Payer: First Health Commercial |
$23.30
|
| Rate for Payer: Humana Commercial |
$20.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$21.59
|
| Rate for Payer: Ohio Health Group HMO |
$18.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.60
|
| Rate for Payer: PHCS Commercial |
$23.55
|
| Rate for Payer: United Healthcare All Payer |
$21.59
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
ANAL SP INF PMP W/REPRG&FILL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
76102303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.00
|
| Rate for Payer: Anthem Medicaid |
$28.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$213.06
|
| Rate for Payer: Healthspan PPO |
$115.01
|
| Rate for Payer: Humana Medicaid |
$28.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.03
|
| Rate for Payer: Molina Healthcare Passport |
$28.46
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.74
|
|
|
ANAL SP INF PMP W/REPRG&FIL(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761P2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$213.06 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.00
|
| Rate for Payer: Anthem Medicaid |
$28.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$213.06
|
| Rate for Payer: Healthspan PPO |
$115.01
|
| Rate for Payer: Humana Medicaid |
$28.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.03
|
| Rate for Payer: Molina Healthcare Passport |
$28.46
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.74
|
|
|
ANAL SP INF PMP W/REPRG&FIL(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761T2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ANAL SP INF PMP W/REPRG&FIL(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 62369
|
| Hospital Charge Code |
761T2303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem Medicaid |
$219.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Humana KY Medicaid |
$219.41
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$221.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.78
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Aetna Commercial |
$314.34
|
| Rate for Payer: Anthem Medicaid |
$75.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$638.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$308.36
|
| Rate for Payer: Healthspan PPO |
$251.34
|
| Rate for Payer: Humana Medicaid |
$75.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.97
|
| Rate for Payer: Molina Healthcare Passport |
$75.46
|
| Rate for Payer: Multiplan PHCS |
$382.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$446.60
|
| Rate for Payer: UHCCP Medicaid |
$223.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.21
|
|
|
ANAL/URINARY MUSCLE STUDY
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.78
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
ANAL/URINARY MUSCLE STUDY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320P0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$314.34 |
| Rate for Payer: Aetna Commercial |
$314.34
|
| Rate for Payer: Anthem Medicaid |
$75.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$308.36
|
| Rate for Payer: Healthspan PPO |
$251.34
|
| Rate for Payer: Humana Medicaid |
$75.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$104.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.97
|
| Rate for Payer: Molina Healthcare Passport |
$75.46
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.21
|
|
|
ANAL/URINARY MUSCLE STUDY(T
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320T0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.78
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
ANAL/URINARY MUSCLE STUDY(T
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
HCPCS 51784
|
| Hospital Charge Code |
320T0264
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$337.26
|
| Rate for Payer: Anthem Medicaid |
$150.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$363.54
|
| Rate for Payer: First Health Commercial |
$416.10
|
| Rate for Payer: Humana Commercial |
$372.30
|
| Rate for Payer: Humana KY Medicaid |
$150.63
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$152.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$359.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$323.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$385.44
|
| Rate for Payer: Ohio Health Group HMO |
$328.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$56.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$135.78
|
| Rate for Payer: PHCS Commercial |
$420.48
|
| Rate for Payer: United Healthcare All Payer |
$385.44
|
|
|
ANALYZE NEURO WITHOUT PROGRAMI
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
ANALYZE NEURO WITHOUT PROGRAMI
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
ANALYZE NEURO WITHOUT PROGRAMI
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
51000041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna Commercial |
$35.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.48
|
| Rate for Payer: Anthem Medicaid |
$17.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$74.64
|
| Rate for Payer: Healthspan PPO |
$66.24
|
| Rate for Payer: Humana Medicaid |
$17.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.91
|
| Rate for Payer: Molina Healthcare Passport |
$17.56
|
| Rate for Payer: Multiplan PHCS |
$241.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.40
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.74
|
|
|
ANALYZE NEURO W/O PROGRAMI(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510P0041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.48 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$35.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.48
|
| Rate for Payer: Anthem Medicaid |
$17.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$74.64
|
| Rate for Payer: Healthspan PPO |
$66.24
|
| Rate for Payer: Humana Medicaid |
$17.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.91
|
| Rate for Payer: Molina Healthcare Passport |
$17.56
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.74
|
|
|
ANALYZE NEURO W/O PROGRAMI(T
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510T0041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.12
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
ANALYZE NEURO W/O PROGRAMI(T
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 95970
|
| Hospital Charge Code |
510T0041
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$86.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$86.66
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$87.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.12
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
ANALYZE SPINE INFUS PUMP
|
Facility
|
OP
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$753.26 |
| Rate for Payer: Aetna Commercial |
$604.18
|
| Rate for Payer: Anthem Medicaid |
$269.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$651.26
|
| Rate for Payer: First Health Commercial |
$745.42
|
| Rate for Payer: Humana Commercial |
$666.95
|
| Rate for Payer: Humana KY Medicaid |
$269.84
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$272.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.49
|
| Rate for Payer: Ohio Health Group HMO |
$588.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.24
|
| Rate for Payer: PHCS Commercial |
$753.26
|
| Rate for Payer: United Healthcare All Payer |
$690.49
|
|
