|
ABLATION OF MALIGNANT PROSTATE TISSUE, TRANSRECTAL, WITH HIGH INTENSITY-FOCUSED ULTRASOUND (HIFU), INCLUDING ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$11,961.85
|
|
|
Service Code
|
CPT 55880
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,544.18 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
|
|
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: Ambetter Exchange |
$1,378.11
|
| Rate for Payer: Anthem Medicaid |
$851.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,378.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,378.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,653.73
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,378.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.11
|
| 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 |
$1,791.54
|
| Rate for Payer: UHCCP Medicaid |
$690.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,378.11
|
|
|
ABLATION OPEN
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
HCPCS 47380
|
| Hospital Charge Code |
76102572
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.90 |
| 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 |
$1,578.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,716.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.37
|
| 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 |
$591.90 |
| 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 |
$1,578.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,716.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.37
|
| Rate for Payer: PHCS Commercial |
$1,894.08
|
| Rate for Payer: United Healthcare All Payer |
$1,736.24
|
|
|
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: Ambetter Exchange |
$1,378.11
|
| Rate for Payer: Anthem Medicaid |
$851.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,378.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,378.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,653.73
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,378.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.11
|
| 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 |
$1,791.54
|
| Rate for Payer: UHCCP Medicaid |
$690.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,378.11
|
|
|
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: Ambetter Exchange |
$217.53
|
| 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 Individual/Medicaid |
$217.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.04
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$217.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.53
|
| 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 |
$282.79
|
| Rate for Payer: UHCCP Medicaid |
$145.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.53
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
76102054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.00 |
| 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 |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
ABLATION RNL TUMOR UNILAT PERC
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 50593
|
| Hospital Charge Code |
76102054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.41 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| 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 |
$9,619.76
|
| 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 |
$11,543.71
|
| 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 |
$536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.30
|
| 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 |
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: Ambetter Exchange |
$427.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.18
|
| Rate for Payer: Anthem Medicaid |
$3,687.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.62
|
| 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 |
$3,687.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,761.14
|
| Rate for Payer: Molina Healthcare Passport |
$3,687.39
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.33
|
| Rate for Payer: UHCCP Medicaid |
$252.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,724.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.18
|
|
|
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: Ambetter Exchange |
$427.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.18
|
| Rate for Payer: Anthem Medicaid |
$3,687.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$512.62
|
| 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 |
$3,687.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$427.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,761.14
|
| Rate for Payer: Molina Healthcare Passport |
$3,687.39
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.33
|
| Rate for Payer: UHCCP Medicaid |
$252.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,724.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.18
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$1,916.14
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,368.67 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ
|
Facility
|
OP
|
$3,705.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
32001025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,274.15 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$2,852.85
|
| Rate for Payer: Anthem Medicaid |
$1,274.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,889.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cigna Commercial |
$3,075.15
|
| Rate for Payer: First Health Commercial |
$3,519.75
|
| Rate for Payer: Humana Commercial |
$3,149.25
|
| Rate for Payer: Humana KY Medicaid |
$1,274.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,287.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,038.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,299.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,260.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,778.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,223.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,556.45
|
| Rate for Payer: PHCS Commercial |
$3,556.80
|
| Rate for Payer: United Healthcare All Payer |
$3,260.40
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
32001025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$300.23 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Ambetter Exchange |
$300.23
|
| Rate for Payer: Anthem Medicaid |
$1,938.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.28
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Humana Medicaid |
$1,938.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,977.64
|
| Rate for Payer: Molina Healthcare Passport |
$1,938.86
|
| Rate for Payer: Multiplan PHCS |
$2,223.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.30
|
| Rate for Payer: UHCCP Medicaid |
$1,296.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,958.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.23
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ
|
Facility
|
IP
|
$3,705.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
32001025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,111.50 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$2,852.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,889.90
|
| Rate for Payer: Cash Price |
$1,852.50
|
| Rate for Payer: Cigna Commercial |
$3,075.15
|
| Rate for Payer: First Health Commercial |
$3,519.75
|
| Rate for Payer: Humana Commercial |
$3,149.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,038.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,111.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,260.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,778.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,223.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,556.45
|
| Rate for Payer: PHCS Commercial |
$3,556.80
|
| Rate for Payer: United Healthcare All Payer |
$3,260.40
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ(P
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
320P1025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Ambetter Exchange |
$300.23
|
| Rate for Payer: Anthem Medicaid |
$1,938.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.28
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Humana Medicaid |
$1,938.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$300.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,977.64
|
| Rate for Payer: Molina Healthcare Passport |
$1,938.86
|
| Rate for Payer: Multiplan PHCS |
$444.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.30
|
| Rate for Payer: UHCCP Medicaid |
$259.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,958.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.23
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ(T
|
Facility
|
OP
|
$2,965.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
320T1025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,019.66 |
| Max. Negotiated Rate |
$2,846.40 |
| Rate for Payer: Aetna Commercial |
$2,283.05
|
| Rate for Payer: Anthem Medicaid |
$1,019.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,312.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,482.50
|
| Rate for Payer: Cash Price |
$1,482.50
|
| Rate for Payer: Cigna Commercial |
$2,460.95
|
| Rate for Payer: First Health Commercial |
$2,816.75
|
| Rate for Payer: Humana Commercial |
$2,520.25
|
| Rate for Payer: Humana KY Medicaid |
$1,019.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,030.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,040.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,579.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,045.85
|
| Rate for Payer: PHCS Commercial |
$2,846.40
|
| Rate for Payer: United Healthcare All Payer |
$2,609.20
|
|
|
ABLTJ 1/+THYR NDUL 1LOBE PRQ(T
|
Facility
|
IP
|
$2,965.00
|
|
|
Service Code
|
HCPCS 60660
|
| Hospital Charge Code |
320T1025
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$889.50 |
| Max. Negotiated Rate |
$2,846.40 |
| Rate for Payer: Aetna Commercial |
$2,283.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,312.70
|
| Rate for Payer: Cash Price |
$1,482.50
|
| Rate for Payer: Cigna Commercial |
$2,460.95
|
| Rate for Payer: First Health Commercial |
$2,816.75
|
| Rate for Payer: Humana Commercial |
$2,520.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,431.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,188.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$889.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,609.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,372.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,579.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,045.85
|
| Rate for Payer: PHCS Commercial |
$2,846.40
|
| Rate for Payer: United Healthcare All Payer |
$2,609.20
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
32001026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.00 |
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
32001026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| 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: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| 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: Molina Healthcare Medicaid |
$701.60
|
| 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 |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
32001026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.72 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Ambetter Exchange |
$208.72
|
| Rate for Payer: Anthem Medicaid |
$323.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.46
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Humana Medicaid |
$323.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$208.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.83
|
| Rate for Payer: Molina Healthcare Passport |
$323.36
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.34
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.72
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ(P
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
320P1026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$329.83 |
| Rate for Payer: Ambetter Exchange |
$208.72
|
| Rate for Payer: Anthem Medicaid |
$323.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$208.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$208.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.46
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Humana Medicaid |
$323.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$208.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.83
|
| Rate for Payer: Molina Healthcare Passport |
$323.36
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.34
|
| Rate for Payer: UHCCP Medicaid |
$180.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$326.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$208.72
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ(T
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
320T1026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
ABLTJ 1/+THYR NDUL ADDL PRQ(T
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS 60661
|
| Hospital Charge Code |
320T1026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
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 |
$1,203.97 |
| Rate for Payer: Ambetter Exchange |
$926.13
|
| Rate for Payer: Anthem Medicaid |
$800.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$926.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$926.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,111.36
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Humana Medicaid |
$800.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$926.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.13
|
| 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 |
$1,203.97
|
| Rate for Payer: UHCCP Medicaid |
$343.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$808.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$926.13
|
|
|
ABLTJ MAL PRST8 TISS HIFU
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 55880
|
| Hospital Charge Code |
76102853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| 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 |
$8,544.18
|
| 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 |
$10,253.02
|
| 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 |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
