|
IR PLMT URETERAL STENT
|
Facility
|
IP
|
$7,676.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$997.88 |
| Max. Negotiated Rate |
$7,368.96 |
| Rate for Payer: Aetna Commercial |
$5,910.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,987.28
|
| Rate for Payer: Cash Price |
$3,838.00
|
| Rate for Payer: Cigna Commercial |
$6,371.08
|
| Rate for Payer: First Health Commercial |
$7,292.20
|
| Rate for Payer: Humana Commercial |
$6,524.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,294.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,757.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.56
|
| Rate for Payer: PHCS Commercial |
$7,368.96
|
| Rate for Payer: United Healthcare All Payer |
$6,754.88
|
|
|
IR PLMT URETERAL STENT (P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
320P1019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.98 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$178.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$365.04
|
| Rate for Payer: Humana Medicaid |
$178.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.23
|
| Rate for Payer: Molina Healthcare Passport |
$178.66
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.45
|
|
|
IR PLMT URETERAL STENT (T
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
320T1019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$862.68 |
| Max. Negotiated Rate |
$6,370.56 |
| Rate for Payer: Aetna Commercial |
$5,109.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,176.08
|
| Rate for Payer: Cash Price |
$3,318.00
|
| Rate for Payer: Cigna Commercial |
$5,507.88
|
| Rate for Payer: First Health Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial |
$5,640.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,441.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,897.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,990.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,839.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,977.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,057.16
|
| Rate for Payer: PHCS Commercial |
$6,370.56
|
| Rate for Payer: United Healthcare All Payer |
$5,839.68
|
|
|
IR PLMT URETERAL STENT (T
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
320T1019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$862.68 |
| Max. Negotiated Rate |
$6,370.56 |
| Rate for Payer: Aetna Commercial |
$5,109.72
|
| Rate for Payer: Anthem Medicaid |
$2,282.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,176.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$3,318.00
|
| Rate for Payer: Cash Price |
$3,318.00
|
| Rate for Payer: Cigna Commercial |
$5,507.88
|
| Rate for Payer: First Health Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial |
$5,640.60
|
| Rate for Payer: Humana KY Medicaid |
$2,282.12
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,305.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,441.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,897.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,327.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,839.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,977.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,327.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,057.16
|
| Rate for Payer: PHCS Commercial |
$6,370.56
|
| Rate for Payer: United Healthcare All Payer |
$5,839.68
|
|
|
IR replace tunneled CV Cath
|
Facility
|
OP
|
$6,424.00
|
|
| Hospital Charge Code |
32000998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.12 |
| Max. Negotiated Rate |
$6,167.04 |
| Rate for Payer: Aetna Commercial |
$4,946.48
|
| Rate for Payer: Anthem Medicaid |
$2,209.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,010.72
|
| Rate for Payer: Cash Price |
$3,212.00
|
| Rate for Payer: Cigna Commercial |
$5,331.92
|
| Rate for Payer: First Health Commercial |
$6,102.80
|
| Rate for Payer: Humana Commercial |
$5,460.40
|
| Rate for Payer: Humana KY Medicaid |
$2,209.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,231.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,267.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,740.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,927.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,253.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,653.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.44
|
| Rate for Payer: PHCS Commercial |
$6,167.04
|
| Rate for Payer: United Healthcare All Payer |
$5,653.12
|
|
|
IR replace tunneled CV Cath
|
Facility
|
IP
|
$6,424.00
|
|
| Hospital Charge Code |
32000998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.12 |
| Max. Negotiated Rate |
$6,167.04 |
| Rate for Payer: Aetna Commercial |
$4,946.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,010.72
|
| Rate for Payer: Cash Price |
$3,212.00
|
| Rate for Payer: Cigna Commercial |
$5,331.92
|
| Rate for Payer: First Health Commercial |
$6,102.80
|
| Rate for Payer: Humana Commercial |
$5,460.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,267.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,740.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,927.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,653.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,818.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,991.44
|
| Rate for Payer: PHCS Commercial |
$6,167.04
|
| Rate for Payer: United Healthcare All Payer |
$5,653.12
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$721.75
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
761T2133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.83 |
| Max. Negotiated Rate |
$692.88 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Anthem Medicaid |
$248.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$562.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$360.88
|
| Rate for Payer: Cash Price |
$360.88
|
| Rate for Payer: Cigna Commercial |
$599.05
|
| Rate for Payer: First Health Commercial |
$685.66
|
| Rate for Payer: Humana Commercial |
$613.49
|
| Rate for Payer: Humana KY Medicaid |
$248.21
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$250.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$591.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$635.14
|
| Rate for Payer: Ohio Health Group HMO |
$541.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.74
|
| Rate for Payer: PHCS Commercial |
$692.88
|
| Rate for Payer: United Healthcare All Payer |
$635.14
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$1,321.75
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.83 |
| Max. Negotiated Rate |
$1,268.88 |
| Rate for Payer: Aetna Commercial |
$1,017.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,030.96
|
| Rate for Payer: Cash Price |
$660.88
|
| Rate for Payer: Cigna Commercial |
$1,097.05
|
| Rate for Payer: First Health Commercial |
$1,255.66
|
| Rate for Payer: Humana Commercial |
$1,123.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,083.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$975.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,163.14
|
| Rate for Payer: Ohio Health Group HMO |
$991.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.74
|
| Rate for Payer: PHCS Commercial |
$1,268.88
|
| Rate for Payer: United Healthcare All Payer |
$1,163.14
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$721.75
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
761T2133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.83 |
| Max. Negotiated Rate |
$692.88 |
| Rate for Payer: Aetna Commercial |
$555.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$562.96
|
| Rate for Payer: Cash Price |
$360.88
|
| Rate for Payer: Cigna Commercial |
$599.05
|
| Rate for Payer: First Health Commercial |
$685.66
|
| Rate for Payer: Humana Commercial |
$613.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$591.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$532.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$635.14
|
| Rate for Payer: Ohio Health Group HMO |
$541.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.74
|
| Rate for Payer: PHCS Commercial |
$692.88
|
| Rate for Payer: United Healthcare All Payer |
$635.14
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
45000284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.14
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
45000284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$378.24 |
| Rate for Payer: Aetna Commercial |
$303.38
|
| Rate for Payer: Anthem Medicaid |
$135.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$307.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cash Price |
$197.00
|
| Rate for Payer: Cigna Commercial |
$327.02
|
| Rate for Payer: First Health Commercial |
$374.30
|
| Rate for Payer: Humana Commercial |
$334.90
|
| Rate for Payer: Humana KY Medicaid |
$135.50
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$136.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$290.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$346.72
|
| Rate for Payer: Ohio Health Group HMO |
$295.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.14
|
| Rate for Payer: PHCS Commercial |
$378.24
|
| Rate for Payer: United Healthcare All Payer |
$346.72
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Professional
|
Both
|
$1,321.75
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Aetna Commercial |
$220.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.48
|
| Rate for Payer: Anthem Medicaid |
$117.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,321.75
|
| Rate for Payer: Cash Price |
$660.88
|
| Rate for Payer: Cash Price |
$660.88
|
| Rate for Payer: Cigna Commercial |
$196.80
|
| Rate for Payer: Healthspan PPO |
$326.82
|
| Rate for Payer: Humana Medicaid |
$117.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$184.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.87
|
| Rate for Payer: Molina Healthcare Passport |
$117.52
|
| Rate for Payer: Multiplan PHCS |
$793.05
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$925.22
|
| Rate for Payer: UHCCP Medicaid |
$70.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.70
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
761P2133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$220.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.48
|
| Rate for Payer: Anthem Medicaid |
$117.52
|
| 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 |
$196.80
|
| Rate for Payer: Healthspan PPO |
$326.82
|
| Rate for Payer: Humana Medicaid |
$117.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$184.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.87
|
| Rate for Payer: Molina Healthcare Passport |
$117.52
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$70.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.70
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$1,321.75
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.83 |
| Max. Negotiated Rate |
$1,268.88 |
| Rate for Payer: Aetna Commercial |
$1,017.75
|
| Rate for Payer: Anthem Medicaid |
$454.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,030.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$660.88
|
| Rate for Payer: Cash Price |
$660.88
|
| Rate for Payer: Cigna Commercial |
$1,097.05
|
| Rate for Payer: First Health Commercial |
$1,255.66
|
| Rate for Payer: Humana Commercial |
$1,123.49
|
| Rate for Payer: Humana KY Medicaid |
$454.55
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$459.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,083.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$975.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$463.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,163.14
|
| Rate for Payer: Ohio Health Group HMO |
$991.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$409.74
|
| Rate for Payer: PHCS Commercial |
$1,268.88
|
| Rate for Payer: United Healthcare All Payer |
$1,163.14
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$37.81
|
| Rate for Payer: Anthem Medicaid |
$23.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$41.48
|
| Rate for Payer: Healthspan PPO |
$35.43
|
| Rate for Payer: Humana Medicaid |
$23.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.15
|
| Rate for Payer: Molina Healthcare Passport |
$23.68
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.92
|
|
|
IR SPECIAL DEV PROC PER 15MIN
|
Facility
|
OP
|
$4,784.00
|
|
| Hospital Charge Code |
32000382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$621.92 |
| Max. Negotiated Rate |
$4,592.64 |
| Rate for Payer: Aetna Commercial |
$3,683.68
|
| Rate for Payer: Anthem Medicaid |
$1,645.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.52
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$3,970.72
|
| Rate for Payer: First Health Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial |
$4,066.40
|
| Rate for Payer: Humana KY Medicaid |
$1,645.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,678.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.04
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
|
IR SPECIAL DEV PROC PER 15MIN
|
Facility
|
IP
|
$4,784.00
|
|
| Hospital Charge Code |
32000382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$621.92 |
| Max. Negotiated Rate |
$4,592.64 |
| Rate for Payer: Aetna Commercial |
$3,683.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.52
|
| Rate for Payer: Cash Price |
$2,392.00
|
| Rate for Payer: Cigna Commercial |
$3,970.72
|
| Rate for Payer: First Health Commercial |
$4,544.80
|
| Rate for Payer: Humana Commercial |
$4,066.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.04
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
|
IR SPLENOPORTOGRAPHY
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75810
|
| Hospital Charge Code |
76102439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
IR SPLENOPORTOGRAPHY
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75810
|
| Hospital Charge Code |
76102439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem Medicaid |
$1,075.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Humana KY Medicaid |
$1,075.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
IR TRANSCATHETER BIOPSY
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
32000178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.98
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
IR TRANSCATHETER BIOPSY
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 75970
|
| Hospital Charge Code |
32000178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$21,895.54
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$14,857.69 |
| Max. Negotiated Rate |
$21,895.54 |
| Rate for Payer: Anthem Medicaid |
$14,857.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,639.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,895.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,113.55
|
| Rate for Payer: Humana KY Medicaid |
$14,857.69
|
| Rate for Payer: Humana Medicare Advantage |
$15,639.67
|
| Rate for Payer: Kentucky WC Medicaid |
$15,006.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,767.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,154.84
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$32,787.71
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$22,248.80 |
| Max. Negotiated Rate |
$32,787.71 |
| Rate for Payer: Anthem Medicaid |
$22,248.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,419.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,787.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$31,616.72
|
| Rate for Payer: Humana KY Medicaid |
$22,248.80
|
| Rate for Payer: Humana Medicare Advantage |
$23,419.79
|
| Rate for Payer: Kentucky WC Medicaid |
$22,471.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,103.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,693.78
|
|
