|
IRON MAN WIRE 300CM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
IRON MAN WIRE 300CM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
IRON SERUM
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
IRON SERUM
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: Aetna Commercial |
$10.13
|
| Rate for Payer: Ambetter Exchange |
$6.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.76
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$5.78
|
| Rate for Payer: Healthspan PPO |
$6.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.47
|
| Rate for Payer: Multiplan PHCS |
$49.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$28.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.47
|
|
|
IRON SERUM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 83540
|
| Hospital Charge Code |
30000431
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.58
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
|
IR PLMT URETERAL STENT
|
Facility
|
IP
|
$7,908.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,372.40 |
| Max. Negotiated Rate |
$7,591.68 |
| Rate for Payer: Aetna Commercial |
$6,089.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,168.24
|
| Rate for Payer: Cash Price |
$3,954.00
|
| Rate for Payer: Cigna Commercial |
$6,563.64
|
| Rate for Payer: First Health Commercial |
$7,512.60
|
| Rate for Payer: Humana Commercial |
$6,721.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,484.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,836.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,372.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,959.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,879.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,456.52
|
| Rate for Payer: PHCS Commercial |
$7,591.68
|
| Rate for Payer: United Healthcare All Payer |
$6,959.04
|
|
|
IR PLMT URETERAL STENT
|
Facility
|
OP
|
$7,908.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,719.56 |
| Max. Negotiated Rate |
$7,591.68 |
| Rate for Payer: Aetna Commercial |
$6,089.16
|
| Rate for Payer: Anthem Medicaid |
$2,719.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,168.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$3,954.00
|
| Rate for Payer: Cash Price |
$3,954.00
|
| Rate for Payer: Cigna Commercial |
$6,563.64
|
| Rate for Payer: First Health Commercial |
$7,512.60
|
| Rate for Payer: Humana Commercial |
$6,721.80
|
| Rate for Payer: Humana KY Medicaid |
$2,719.56
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,484.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,836.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,959.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,931.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,879.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,456.52
|
| Rate for Payer: PHCS Commercial |
$7,591.68
|
| Rate for Payer: United Healthcare All Payer |
$6,959.04
|
|
|
IR PLMT URETERAL STENT
|
Professional
|
Both
|
$7,908.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
32001019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.98 |
| Max. Negotiated Rate |
$4,744.80 |
| Rate for Payer: Ambetter Exchange |
$189.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$791.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.04
|
| Rate for Payer: Cash Price |
$3,954.00
|
| Rate for Payer: Cash Price |
$3,954.00
|
| Rate for Payer: Cigna Commercial |
$365.04
|
| Rate for Payer: Humana Medicaid |
$791.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$807.40
|
| Rate for Payer: Molina Healthcare Passport |
$791.57
|
| Rate for Payer: Multiplan PHCS |
$4,744.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.96
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$799.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.20
|
|
|
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 |
$807.40 |
| Rate for Payer: Ambetter Exchange |
$189.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$791.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.04
|
| 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 |
$791.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$807.40
|
| Rate for Payer: Molina Healthcare Passport |
$791.57
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.96
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$799.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.20
|
|
|
IR PLMT URETERAL STENT (T
|
Facility
|
OP
|
$6,868.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
320T1019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,361.91 |
| Max. Negotiated Rate |
$6,593.28 |
| Rate for Payer: Aetna Commercial |
$5,288.36
|
| Rate for Payer: Anthem Medicaid |
$2,361.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$3,434.00
|
| Rate for Payer: Cash Price |
$3,434.00
|
| Rate for Payer: Cigna Commercial |
$5,700.44
|
| Rate for Payer: First Health Commercial |
$6,524.60
|
| Rate for Payer: Humana Commercial |
$5,837.80
|
| Rate for Payer: Humana KY Medicaid |
$2,361.91
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,385.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,631.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,409.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,043.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,975.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,738.92
|
| Rate for Payer: PHCS Commercial |
$6,593.28
|
| Rate for Payer: United Healthcare All Payer |
$6,043.84
|
|
|
IR PLMT URETERAL STENT (T
|
Facility
|
IP
|
$6,868.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
320T1019
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,060.40 |
| Max. Negotiated Rate |
$6,593.28 |
| Rate for Payer: Aetna Commercial |
$5,288.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,357.04
|
| Rate for Payer: Cash Price |
$3,434.00
|
| Rate for Payer: Cigna Commercial |
$5,700.44
|
| Rate for Payer: First Health Commercial |
$6,524.60
|
| Rate for Payer: Humana Commercial |
$5,837.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,631.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,043.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,151.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,975.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,738.92
|
| Rate for Payer: PHCS Commercial |
$6,593.28
|
| Rate for Payer: United Healthcare All Payer |
$6,043.84
|
|
|
IR replace tunneled CV Cath
|
Facility
|
OP
|
$6,424.00
|
|
| Hospital Charge Code |
32000998
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.20 |
| 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 |
$5,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,588.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,432.56
|
| 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 |
$1,927.20 |
| 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 |
$5,139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,588.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,432.56
|
| Rate for Payer: PHCS Commercial |
$6,167.04
|
| Rate for Payer: United Healthcare All Payer |
$5,653.12
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
45000284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem Medicaid |
$256.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Humana KY Medicaid |
$256.89
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$259.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.43
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$1,347.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,293.12 |
| Rate for Payer: Aetna Commercial |
$1,037.19
|
| Rate for Payer: Anthem Medicaid |
$463.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,050.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$1,118.01
|
| Rate for Payer: First Health Commercial |
$1,279.65
|
| Rate for Payer: Humana Commercial |
$1,144.95
|
| Rate for Payer: Humana KY Medicaid |
$463.23
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$467.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,104.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$472.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,185.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,077.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,171.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$929.43
|
| Rate for Payer: PHCS Commercial |
$1,293.12
|
| Rate for Payer: United Healthcare All Payer |
$1,185.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
45000284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.10 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.43
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$1,347.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.10 |
| Max. Negotiated Rate |
$1,293.12 |
| Rate for Payer: Aetna Commercial |
$1,037.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,050.66
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cigna Commercial |
$1,118.01
|
| Rate for Payer: First Health Commercial |
$1,279.65
|
| Rate for Payer: Humana Commercial |
$1,144.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,104.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,185.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,077.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,171.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$929.43
|
| Rate for Payer: PHCS Commercial |
$1,293.12
|
| Rate for Payer: United Healthcare All Payer |
$1,185.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
761T2133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem Medicaid |
$256.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Humana KY Medicaid |
$256.89
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$259.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.43
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
761T2133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.10 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$575.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$582.66
|
| Rate for Payer: Cash Price |
$373.50
|
| Rate for Payer: Cigna Commercial |
$620.01
|
| Rate for Payer: First Health Commercial |
$709.65
|
| Rate for Payer: Humana Commercial |
$634.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$612.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$551.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$657.36
|
| Rate for Payer: Ohio Health Group HMO |
$560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$515.43
|
| Rate for Payer: PHCS Commercial |
$717.12
|
| Rate for Payer: United Healthcare All Payer |
$657.36
|
|
|
IRRIG CORP CAVERNOSA PRIAPISAM
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
HCPCS 54220
|
| Hospital Charge Code |
76102133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.48 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna Commercial |
$220.85
|
| Rate for Payer: Ambetter Exchange |
$127.26
|
| 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 Individual/Medicaid |
$127.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.71
|
| Rate for Payer: Cash Price |
$673.50
|
| Rate for Payer: Cash Price |
$673.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$127.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.87
|
| Rate for Payer: Molina Healthcare Passport |
$117.52
|
| Rate for Payer: Multiplan PHCS |
$808.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.44
|
| Rate for Payer: UHCCP Medicaid |
$70.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.26
|
|
|
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 |
$360.00 |
| Rate for Payer: Aetna Commercial |
$220.85
|
| Rate for Payer: Ambetter Exchange |
$127.26
|
| 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 Individual/Medicaid |
$127.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.71
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$127.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.26
|
| 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 |
$165.44
|
| Rate for Payer: UHCCP Medicaid |
$70.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.26
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$21.37 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$37.81
|
| Rate for Payer: Ambetter Exchange |
$21.37
|
| Rate for Payer: Anthem Medicaid |
$23.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.64
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$21.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.15
|
| Rate for Payer: Molina Healthcare Passport |
$23.68
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.78
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.37
|
|
|
IRRIG DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 96523
|
| Hospital Charge Code |
94000007
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
IR SPECIAL DEV PROC PER 15MIN
|
Facility
|
IP
|
$4,784.00
|
|
| Hospital Charge Code |
32000382
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,435.20 |
| 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 |
$3,827.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,162.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.96
|
| Rate for Payer: PHCS Commercial |
$4,592.64
|
| Rate for Payer: United Healthcare All Payer |
$4,209.92
|
|
