|
PELVIS 1-2 VWS
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Ambetter Exchange |
$25.32
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.38
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$41.44
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Humana Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.68
|
| Rate for Payer: Molina Healthcare Passport |
$21.25
|
| Rate for Payer: Multiplan PHCS |
$212.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.92
|
| Rate for Payer: UHCCP Medicaid |
$123.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.32
|
|
|
PELVIS 1-2 VWS
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
PELVIS 1-2 VWS
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
61000023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
PELVIS 1-2 VWS(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
610P0023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$41.44 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Ambetter Exchange |
$25.32
|
| Rate for Payer: Anthem Medicaid |
$21.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.38
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$41.44
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Humana Medicaid |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.68
|
| Rate for Payer: Molina Healthcare Passport |
$21.25
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.92
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.32
|
|
|
PELVIS 1-2 VWS(T
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
610T0023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
PELVIS 1-2 VWS(T
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 72170
|
| Hospital Charge Code |
610T0023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.66
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
PEN-GK 600KU(from20MMU MDV)
|
Facility
|
OP
|
$8.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
25004242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Anthem Medicaid |
$2.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.51
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: First Health Commercial |
$7.92
|
| Rate for Payer: Humana Commercial |
$7.09
|
| Rate for Payer: Humana KY Medicaid |
$2.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.34
|
| Rate for Payer: Ohio Health Group HMO |
$6.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.75
|
| Rate for Payer: PHCS Commercial |
$8.01
|
| Rate for Payer: United Healthcare All Payer |
$7.34
|
|
|
PEN-GK 600KU(from20MMU MDV)
|
Facility
|
IP
|
$8.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
25004242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.51
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: First Health Commercial |
$7.92
|
| Rate for Payer: Humana Commercial |
$7.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.34
|
| Rate for Payer: Ohio Health Group HMO |
$6.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.75
|
| Rate for Payer: PHCS Commercial |
$8.01
|
| Rate for Payer: United Healthcare All Payer |
$7.34
|
|
|
PEN-GK 600KU(FROM20MMU MDV)AIC
|
Facility
|
IP
|
$8.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
25004243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.51
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: First Health Commercial |
$7.92
|
| Rate for Payer: Humana Commercial |
$7.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.34
|
| Rate for Payer: Ohio Health Group HMO |
$6.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.75
|
| Rate for Payer: PHCS Commercial |
$8.01
|
| Rate for Payer: United Healthcare All Payer |
$7.34
|
|
|
PEN-GK 600KU(FROM20MMU MDV)AIC
|
Facility
|
OP
|
$8.34
|
|
|
Service Code
|
HCPCS J2540
|
| Hospital Charge Code |
25004243
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$6.42
|
| Rate for Payer: Anthem Medicaid |
$2.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.51
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: First Health Commercial |
$7.92
|
| Rate for Payer: Humana Commercial |
$7.09
|
| Rate for Payer: Humana KY Medicaid |
$2.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.34
|
| Rate for Payer: Ohio Health Group HMO |
$6.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.75
|
| Rate for Payer: PHCS Commercial |
$8.01
|
| Rate for Payer: United Healthcare All Payer |
$7.34
|
|
|
PENICILLIUM NOTATUM IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000706
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
PENICILLIUM NOTATUM IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000706
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
PENILE INJECTION
|
Facility
|
OP
|
$942.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
76102134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem Medicaid |
$323.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Humana KY Medicaid |
$323.95
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$330.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.98
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
PENILE INJECTION
|
Facility
|
IP
|
$942.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
76102134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$904.32 |
| Rate for Payer: Aetna Commercial |
$725.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.76
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$781.86
|
| Rate for Payer: First Health Commercial |
$894.90
|
| Rate for Payer: Humana Commercial |
$800.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$695.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$828.96
|
| Rate for Payer: Ohio Health Group HMO |
$706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$753.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.98
|
| Rate for Payer: PHCS Commercial |
$904.32
|
| Rate for Payer: United Healthcare All Payer |
$828.96
|
|
|
PENILE INJECTION
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
76102134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna Commercial |
$119.36
|
| Rate for Payer: Ambetter Exchange |
$70.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.84
|
| Rate for Payer: Anthem Medicaid |
$47.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.07
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cash Price |
$471.00
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Healthspan PPO |
$139.92
|
| Rate for Payer: Humana Medicaid |
$47.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.37
|
| Rate for Payer: Molina Healthcare Passport |
$47.42
|
| Rate for Payer: Multiplan PHCS |
$565.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.08
|
| Rate for Payer: UHCCP Medicaid |
$38.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.06
|
|
|
PENILE INJECTION(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
761P2134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$119.36
|
| Rate for Payer: Ambetter Exchange |
$70.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.84
|
| Rate for Payer: Anthem Medicaid |
$47.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.07
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$126.71
|
| Rate for Payer: Healthspan PPO |
$139.92
|
| Rate for Payer: Humana Medicaid |
$47.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$70.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.37
|
| Rate for Payer: Molina Healthcare Passport |
$47.42
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.08
|
| Rate for Payer: UHCCP Medicaid |
$38.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.06
|
|
|
PENILE INJECTION(T
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
761T2134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
PENILE INJECTION(T
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
HCPCS 54235
|
| Hospital Charge Code |
761T2134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem Medicaid |
$160.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Humana KY Medicaid |
$160.60
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$162.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
PENILE VASCULAR STUDY
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,006.08 |
| Rate for Payer: Aetna Commercial |
$806.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$817.44
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cigna Commercial |
$869.84
|
| Rate for Payer: First Health Commercial |
$995.60
|
| Rate for Payer: Humana Commercial |
$890.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$859.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$773.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$922.24
|
| Rate for Payer: Ohio Health Group HMO |
$786.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$911.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.12
|
| Rate for Payer: PHCS Commercial |
$1,006.08
|
| Rate for Payer: United Healthcare All Payer |
$922.24
|
|
|
PENILE VASCULAR STUDY
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$628.80 |
| Rate for Payer: Aetna Commercial |
$287.23
|
| Rate for Payer: Ambetter Exchange |
$106.93
|
| Rate for Payer: Anthem Medicaid |
$175.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.32
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cigna Commercial |
$223.00
|
| Rate for Payer: Healthspan PPO |
$306.83
|
| Rate for Payer: Humana Medicaid |
$175.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.16
|
| Rate for Payer: Molina Healthcare Passport |
$175.65
|
| Rate for Payer: Multiplan PHCS |
$628.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.01
|
| Rate for Payer: UHCCP Medicaid |
$366.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.93
|
|
|
PENILE VASCULAR STUDY
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,006.08 |
| Rate for Payer: Aetna Commercial |
$806.96
|
| Rate for Payer: Anthem Medicaid |
$360.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$817.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cigna Commercial |
$869.84
|
| Rate for Payer: First Health Commercial |
$995.60
|
| Rate for Payer: Humana Commercial |
$890.80
|
| Rate for Payer: Humana KY Medicaid |
$360.41
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$859.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$773.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$367.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$922.24
|
| Rate for Payer: Ohio Health Group HMO |
$786.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$911.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$723.12
|
| Rate for Payer: PHCS Commercial |
$1,006.08
|
| Rate for Payer: United Healthcare All Payer |
$922.24
|
|
|
PENILE VASCULAR STUDY(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
921P0016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$84.01 |
| Max. Negotiated Rate |
$306.83 |
| Rate for Payer: Aetna Commercial |
$287.23
|
| Rate for Payer: Ambetter Exchange |
$106.93
|
| Rate for Payer: Anthem Medicaid |
$175.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.32
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$223.00
|
| Rate for Payer: Healthspan PPO |
$306.83
|
| Rate for Payer: Humana Medicaid |
$175.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$84.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.16
|
| Rate for Payer: Molina Healthcare Passport |
$175.65
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.01
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.93
|
|
|
PENILE VASCULAR STUDY(T
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
921T0016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$236.40 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
PENILE VASCULAR STUDY(T
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS 93980
|
| Hospital Charge Code |
921T0016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$756.48 |
| Rate for Payer: Aetna Commercial |
$606.76
|
| Rate for Payer: Anthem Medicaid |
$270.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$654.04
|
| Rate for Payer: First Health Commercial |
$748.60
|
| Rate for Payer: Humana Commercial |
$669.80
|
| Rate for Payer: Humana KY Medicaid |
$270.99
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$273.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.44
|
| Rate for Payer: Ohio Health Group HMO |
$591.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.72
|
| Rate for Payer: PHCS Commercial |
$756.48
|
| Rate for Payer: United Healthcare All Payer |
$693.44
|
|
|
PENIS PLASTIC SURGERY
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 54360
|
| Hospital Charge Code |
76102966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.83 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| 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 |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
