|
ABLATE ATRIA LMTD ENDO
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
76101276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ABLATE ATRIA LMTD ENDO(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 33265
|
| Hospital Charge Code |
761P1276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,323.28 |
| Rate for Payer: Aetna Commercial |
$2,323.28
|
| Rate for Payer: Anthem Medicaid |
$1,016.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,163.26
|
| Rate for Payer: Healthspan PPO |
$2,284.24
|
| Rate for Payer: Humana Medicaid |
$1,016.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,900.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,036.49
|
| Rate for Payer: Molina Healthcare Passport |
$1,016.17
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,026.33
|
|
|
ABLATION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ABLATION
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.13 |
| Max. Negotiated Rate |
$1,563.61 |
| Rate for Payer: Aetna Commercial |
$335.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.13
|
| Rate for Payer: Anthem Medicaid |
$162.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$330.94
|
| Rate for Payer: Healthspan PPO |
$1,563.61
|
| Rate for Payer: Humana Medicaid |
$162.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.22
|
| Rate for Payer: Molina Healthcare Passport |
$162.96
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$145.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.59
|
|
|
ABLATION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
76102225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ABLATION OF MALIGNANT PROSTATE TISSUE, TRANSRECTAL, WITH HIGH INTENSITY-FOCUSED ULTRASOUND (HIFU), INCLUDING ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$11,152.93
|
|
|
Service Code
|
CPT 55880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,966.38 |
| Max. Negotiated Rate |
$11,152.93 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,966.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,152.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,754.61
|
| Rate for Payer: Humana Medicare Advantage |
$7,966.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,559.66
|
|
|
ABLATION OPEN
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
76102572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.49 |
| Max. Negotiated Rate |
$1,894.08 |
| Rate for Payer: Aetna Commercial |
$1,519.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.94
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,637.59
|
| Rate for Payer: First Health Commercial |
$1,874.35
|
| Rate for Payer: Humana Commercial |
$1,677.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.63
|
| Rate for Payer: PHCS Commercial |
$1,894.08
|
| Rate for Payer: United Healthcare All Payer |
$1,736.24
|
|
|
ABLATION OPEN
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
76102572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.49 |
| Max. Negotiated Rate |
$1,894.08 |
| Rate for Payer: Aetna Commercial |
$1,519.21
|
| Rate for Payer: Anthem Medicaid |
$678.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.94
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,637.59
|
| Rate for Payer: First Health Commercial |
$1,874.35
|
| Rate for Payer: Humana Commercial |
$1,677.05
|
| Rate for Payer: Humana KY Medicaid |
$678.51
|
| Rate for Payer: Kentucky WC Medicaid |
$685.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,736.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.63
|
| Rate for Payer: PHCS Commercial |
$1,894.08
|
| Rate for Payer: United Healthcare All Payer |
$1,736.24
|
|
|
ABLATION OPEN
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
76102572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.55 |
| Max. Negotiated Rate |
$2,105.96 |
| Rate for Payer: Aetna Commercial |
$2,105.96
|
| Rate for Payer: Anthem Medicaid |
$851.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,973.00
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,963.77
|
| Rate for Payer: Healthspan PPO |
$1,775.99
|
| Rate for Payer: Humana Medicaid |
$851.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,841.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.73
|
| Rate for Payer: Molina Healthcare Passport |
$851.70
|
| Rate for Payer: Multiplan PHCS |
$1,183.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,381.10
|
| Rate for Payer: UHCCP Medicaid |
$690.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.22
|
|
|
ABLATION OPEN(P
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
761P2572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.55 |
| Max. Negotiated Rate |
$2,105.96 |
| Rate for Payer: Aetna Commercial |
$2,105.96
|
| Rate for Payer: Anthem Medicaid |
$851.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,973.00
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cash Price |
$986.50
|
| Rate for Payer: Cigna Commercial |
$1,963.77
|
| Rate for Payer: Healthspan PPO |
$1,775.99
|
| Rate for Payer: Humana Medicaid |
$851.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,841.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.73
|
| Rate for Payer: Molina Healthcare Passport |
$851.70
|
| Rate for Payer: Multiplan PHCS |
$1,183.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,381.10
|
| Rate for Payer: UHCCP Medicaid |
$690.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.22
|
|
|
ABLATION(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58353
|
| Hospital Charge Code |
761P2225
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.13 |
| Max. Negotiated Rate |
$1,563.61 |
| Rate for Payer: Aetna Commercial |
$335.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.13
|
| Rate for Payer: Anthem Medicaid |
$162.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$330.94
|
| Rate for Payer: Healthspan PPO |
$1,563.61
|
| Rate for Payer: Humana Medicaid |
$162.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.22
|
| Rate for Payer: Molina Healthcare Passport |
$162.96
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$145.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.59
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
76102054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.18 |
| Max. Negotiated Rate |
$5,508.42 |
| Rate for Payer: Aetna Commercial |
$757.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.18
|
| Rate for Payer: Anthem Medicaid |
$388.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$695.43
|
| Rate for Payer: Healthspan PPO |
$5,508.42
|
| Rate for Payer: Humana Medicaid |
$388.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.75
|
| Rate for Payer: Molina Healthcare Passport |
$388.97
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$252.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.86
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
76102054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
76102054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
761P2054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.18 |
| Max. Negotiated Rate |
$5,508.42 |
| Rate for Payer: Aetna Commercial |
$757.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.18
|
| Rate for Payer: Anthem Medicaid |
$388.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$695.43
|
| Rate for Payer: Healthspan PPO |
$5,508.42
|
| Rate for Payer: Humana Medicaid |
$388.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.75
|
| Rate for Payer: Molina Healthcare Passport |
$388.97
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$252.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.86
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$1,846.31
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,318.79 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
|
|
ABLTJ MAL PRST8 TISS HIFU
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 55880
|
| Hospital Charge Code |
76102853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
ABLTJ MAL PRST8 TISS HIFU
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 55880
|
| Hospital Charge Code |
76102853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$11,152.93 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,966.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,152.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,754.61
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$7,966.38
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,559.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.80
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
ABLTJ MAL PRST8 TISS HIFU
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 55880
|
| Hospital Charge Code |
76102853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Anthem Medicaid |
$800.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$980.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Humana Medicaid |
$800.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$816.45
|
| Rate for Payer: Molina Healthcare Passport |
$800.44
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$686.00
|
| Rate for Payer: UHCCP Medicaid |
$343.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$808.44
|
|
|
ABLYSINOL 5ML AMPULE
|
Facility
|
OP
|
$5,422.75
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$704.96 |
| Max. Negotiated Rate |
$5,205.84 |
| Rate for Payer: Aetna Commercial |
$4,175.52
|
| Rate for Payer: Anthem Medicaid |
$1,864.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,229.74
|
| Rate for Payer: Cash Price |
$2,711.38
|
| Rate for Payer: Cigna Commercial |
$4,500.88
|
| Rate for Payer: First Health Commercial |
$5,151.61
|
| Rate for Payer: Humana Commercial |
$4,609.34
|
| Rate for Payer: Humana KY Medicaid |
$1,864.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,883.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,446.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,001.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,902.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,772.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,067.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,681.05
|
| Rate for Payer: PHCS Commercial |
$5,205.84
|
| Rate for Payer: United Healthcare All Payer |
$4,772.02
|
|
|
ABLYSINOL 5ML AMPULE
|
Facility
|
IP
|
$5,422.75
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$704.96 |
| Max. Negotiated Rate |
$5,205.84 |
| Rate for Payer: Aetna Commercial |
$4,175.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,229.74
|
| Rate for Payer: Cash Price |
$2,711.38
|
| Rate for Payer: Cigna Commercial |
$4,500.88
|
| Rate for Payer: First Health Commercial |
$5,151.61
|
| Rate for Payer: Humana Commercial |
$4,609.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,446.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,001.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,626.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,772.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,067.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,681.05
|
| Rate for Payer: PHCS Commercial |
$5,205.84
|
| Rate for Payer: United Healthcare All Payer |
$4,772.02
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$9,343.36
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$6,340.14 |
| Max. Negotiated Rate |
$9,343.36 |
| Rate for Payer: Anthem Medicaid |
$6,340.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,673.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,343.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,009.67
|
| Rate for Payer: Humana KY Medicaid |
$6,340.14
|
| Rate for Payer: Humana Medicare Advantage |
$6,673.83
|
| Rate for Payer: Kentucky WC Medicaid |
$6,403.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,008.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,466.94
|
|
|
ABORTION WITHOUT D&C
|
Facility
|
IP
|
$11,571.87
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$7,852.34 |
| Max. Negotiated Rate |
$11,571.87 |
| Rate for Payer: Anthem Medicaid |
$7,852.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,265.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,571.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,158.59
|
| Rate for Payer: Humana KY Medicaid |
$7,852.34
|
| Rate for Payer: Humana Medicare Advantage |
$8,265.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,930.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,918.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,009.39
|
|
|
ABRAXANE 1MG/0.2ML(100MG/20ML)
|
Facility
|
IP
|
$8,611.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
25002651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,119.47 |
| Max. Negotiated Rate |
$8,266.88 |
| Rate for Payer: Aetna Commercial |
$6,630.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.84
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cigna Commercial |
$7,147.40
|
| Rate for Payer: First Health Commercial |
$8,180.76
|
| Rate for Payer: Humana Commercial |
$7,319.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.51
|
| Rate for Payer: PHCS Commercial |
$8,266.88
|
| Rate for Payer: United Healthcare All Payer |
$7,577.97
|
|
|
ABRAXANE 1MG/0.2ML(100MG/20ML)
|
Facility
|
OP
|
$8,611.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
25002651
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$8,266.88 |
| Rate for Payer: Aetna Commercial |
$6,630.72
|
| Rate for Payer: Anthem Medicaid |
$2,961.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.30
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cash Price |
$4,305.66
|
| Rate for Payer: Cigna Commercial |
$7,147.40
|
| Rate for Payer: First Health Commercial |
$8,180.76
|
| Rate for Payer: Humana Commercial |
$7,319.63
|
| Rate for Payer: Humana KY Medicaid |
$2,961.44
|
| Rate for Payer: Humana Medicare Advantage |
$14.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.51
|
| Rate for Payer: PHCS Commercial |
$8,266.88
|
| Rate for Payer: United Healthcare All Payer |
$7,577.97
|
|
