|
ASP INJ RENAL CYST PELVIS
|
Professional
|
Both
|
$1,404.00
|
|
|
Service Code
|
HCPCS 50390
|
| Hospital Charge Code |
76102047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$1,404.00 |
| Rate for Payer: Aetna Commercial |
$161.84
|
| Rate for Payer: Anthem Medicaid |
$144.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,404.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cash Price |
$702.00
|
| Rate for Payer: Cigna Commercial |
$144.90
|
| Rate for Payer: Healthspan PPO |
$129.41
|
| Rate for Payer: Humana Medicaid |
$144.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.93
|
| Rate for Payer: Molina Healthcare Passport |
$144.05
|
| Rate for Payer: Multiplan PHCS |
$842.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$982.80
|
| Rate for Payer: UHCCP Medicaid |
$491.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.49
|
|
|
ASP INJ RENAL CYST PELVIS(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 50390
|
| Hospital Charge Code |
761P2047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$161.84
|
| Rate for Payer: Anthem Medicaid |
$144.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$144.90
|
| Rate for Payer: Healthspan PPO |
$129.41
|
| Rate for Payer: Humana Medicaid |
$144.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.93
|
| Rate for Payer: Molina Healthcare Passport |
$144.05
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$185.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.49
|
|
|
ASP INJ RENAL CYST PELVIS(T
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 50390
|
| Hospital Charge Code |
761T2047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
ASP INJ RENAL CYST PELVIS(T
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 50390
|
| Hospital Charge Code |
761T2047
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION
|
Facility
|
OP
|
$358.57
|
|
|
Service Code
|
CPT 20612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.12 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
|
|
ASPIRATION BREAST
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.35
|
| Rate for Payer: Anthem Medicaid |
$31.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,062.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Healthspan PPO |
$125.93
|
| Rate for Payer: Humana Medicaid |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.08
|
| Rate for Payer: Molina Healthcare Passport |
$31.45
|
| Rate for Payer: Multiplan PHCS |
$637.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$743.40
|
| Rate for Payer: UHCCP Medicaid |
$30.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.76
|
|
|
ASPIRATION BREAST
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem Medicaid |
$365.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Humana KY Medicaid |
$365.22
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
ASPIRATION BREAST
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
45000083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
ASPIRATION BREAST
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
ASPIRATION BREAST
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
45000083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
ASPIRATION BREAST(P
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761P0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.35
|
| Rate for Payer: Anthem Medicaid |
$31.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.00
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Healthspan PPO |
$125.93
|
| Rate for Payer: Humana Medicaid |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.08
|
| Rate for Payer: Molina Healthcare Passport |
$31.45
|
| Rate for Payer: Multiplan PHCS |
$90.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.70
|
| Rate for Payer: UHCCP Medicaid |
$30.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.76
|
|
|
ASPIRATION BREAST(T
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761T0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
ASPIRATION BREAST(T
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
761T0274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
ASPIRATION BS NEEDLE W/SHEATH
|
Facility
|
OP
|
$1,904.17
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.54 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$1,466.21
|
| Rate for Payer: Anthem Medicaid |
$654.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.25
|
| Rate for Payer: Cash Price |
$952.08
|
| Rate for Payer: Cigna Commercial |
$1,580.46
|
| Rate for Payer: First Health Commercial |
$1,808.96
|
| Rate for Payer: Humana Commercial |
$1,618.54
|
| Rate for Payer: Humana KY Medicaid |
$654.84
|
| Rate for Payer: Kentucky WC Medicaid |
$661.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.29
|
| Rate for Payer: PHCS Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare All Payer |
$1,675.67
|
|
|
ASPIRATION BS NEEDLE W/SHEATH
|
Facility
|
IP
|
$1,904.17
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.54 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$1,466.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.25
|
| Rate for Payer: Cash Price |
$952.08
|
| Rate for Payer: Cigna Commercial |
$1,580.46
|
| Rate for Payer: First Health Commercial |
$1,808.96
|
| Rate for Payer: Humana Commercial |
$1,618.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.29
|
| Rate for Payer: PHCS Commercial |
$1,828.00
|
| Rate for Payer: United Healthcare All Payer |
$1,675.67
|
|
|
ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.34 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
|
|
ASPIRE RX MECHANICAL TECH. 6FR
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
ASPIRE RX MECHANICAL TECH. 6FR
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,116.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
ASPIRIN 300 MG SUPPO 300MG/1EA
|
Facility
|
OP
|
$9.17
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
25000265
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Humana KY Medicaid |
$3.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
ASPIRIN 300 MG SUPPO 300MG/1EA
|
Facility
|
IP
|
$9.17
|
|
|
Service Code
|
NDC 574703412
|
| Hospital Charge Code |
25000265
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.15
|
| Rate for Payer: Cash Price |
$4.58
|
| Rate for Payer: Cigna Commercial |
$7.61
|
| Rate for Payer: First Health Commercial |
$8.71
|
| Rate for Payer: Humana Commercial |
$7.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.07
|
| Rate for Payer: Ohio Health Group HMO |
$6.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.84
|
| Rate for Payer: PHCS Commercial |
$8.80
|
| Rate for Payer: United Healthcare All Payer |
$8.07
|
|
|
ASPIRIN (BUFFERED) 325MG/1TAB
|
Facility
|
IP
|
$4.22
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
25000264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN (BUFFERED) 325MG/1TAB
|
Facility
|
OP
|
$4.22
|
|
|
Service Code
|
NDC 904201559
|
| Hospital Charge Code |
25000264
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: First Health Commercial |
$4.01
|
| Rate for Payer: Humana Commercial |
$3.59
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.71
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Payer |
$3.71
|
|
|
ASPIRIN CHEW TABLET 81MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
25000267
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN CHEW TABLET 81MG/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 904679480
|
| Hospital Charge Code |
25000267
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
ASPIRIN EC 325 MG T 325MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 57896092110
|
| Hospital Charge Code |
25000268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
