|
PLEUROSCOPY - REMOVE FIBRIN D
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLEUROSCOPY - REMOVE FIBRIN D
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.63 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem Medicaid |
$690.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,586.10
|
| Rate for Payer: Healthspan PPO |
$1,337.66
|
| Rate for Payer: Humana Medicaid |
$690.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,448.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$704.44
|
| Rate for Payer: Molina Healthcare Passport |
$690.63
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$697.54
|
|
|
PLEUROSCOPY - REMOVE FIBRIN D
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
76101216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
PLEUROSCOPY - REMOVE FIBRIN (P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 32653
|
| Hospital Charge Code |
761P1216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.63 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem Medicaid |
$690.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,586.10
|
| Rate for Payer: Healthspan PPO |
$1,337.66
|
| Rate for Payer: Humana Medicaid |
$690.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,448.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$704.44
|
| Rate for Payer: Molina Healthcare Passport |
$690.63
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$697.54
|
|
|
PLEXA PROMRI S 65
|
Facility
|
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
PLEXA PROMRI S 65
|
Facility
|
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,520.35 |
| Max. Negotiated Rate |
$11,227.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.63 |
| Max. Negotiated Rate |
$680.46 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.63
|
| Rate for Payer: Anthem Medicaid |
$332.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$680.46
|
| Rate for Payer: Humana Medicaid |
$332.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.48
|
| Rate for Payer: Molina Healthcare Passport |
$332.82
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.15
|
|
|
PLMT BILIARY DRAINAGE CATH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
76101958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
PLMT BILIARY DRAINAGE CATH(p
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 47534
|
| Hospital Charge Code |
761P1958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.63 |
| Max. Negotiated Rate |
$680.46 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.63
|
| Rate for Payer: Anthem Medicaid |
$332.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$680.46
|
| Rate for Payer: Humana Medicaid |
$332.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$339.48
|
| Rate for Payer: Molina Healthcare Passport |
$332.82
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$336.15
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Facility
|
IP
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.65 |
| Max. Negotiated Rate |
$6,532.80 |
| Rate for Payer: Aetna Commercial |
$5,239.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.90
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$5,648.15
|
| Rate for Payer: First Health Commercial |
$6,464.75
|
| Rate for Payer: Humana Commercial |
$5,784.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.55
|
| Rate for Payer: PHCS Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Payer |
$5,988.40
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Facility
|
OP
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.65 |
| Max. Negotiated Rate |
$6,532.80 |
| Rate for Payer: Aetna Commercial |
$5,239.85
|
| Rate for Payer: Anthem Medicaid |
$2,340.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$5,648.15
|
| Rate for Payer: First Health Commercial |
$6,464.75
|
| Rate for Payer: Humana Commercial |
$5,784.25
|
| Rate for Payer: Humana KY Medicaid |
$2,340.24
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.55
|
| Rate for Payer: PHCS Commercial |
$6,532.80
|
| Rate for Payer: United Healthcare All Payer |
$5,988.40
|
|
|
PLMT NEPHROURETERAL CATHETER
|
Professional
|
Both
|
$6,805.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
76102751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.81 |
| Max. Negotiated Rate |
$6,805.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.81
|
| Rate for Payer: Anthem Medicaid |
$222.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,805.00
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cash Price |
$3,402.50
|
| Rate for Payer: Cigna Commercial |
$455.21
|
| Rate for Payer: Humana Medicaid |
$222.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$372.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.39
|
| Rate for Payer: Molina Healthcare Passport |
$222.93
|
| Rate for Payer: Multiplan PHCS |
$4,083.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,763.50
|
| Rate for Payer: UHCCP Medicaid |
$231.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.16
|
|
|
PLMT NEPHROURETERAL CATHETER(P
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761P2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.81 |
| Max. Negotiated Rate |
$1,145.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.81
|
| Rate for Payer: Anthem Medicaid |
$222.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,145.00
|
| Rate for Payer: Cash Price |
$572.50
|
| Rate for Payer: Cash Price |
$572.50
|
| Rate for Payer: Cigna Commercial |
$455.21
|
| Rate for Payer: Humana Medicaid |
$222.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$372.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$227.39
|
| Rate for Payer: Molina Healthcare Passport |
$222.93
|
| Rate for Payer: Multiplan PHCS |
$687.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.50
|
| Rate for Payer: UHCCP Medicaid |
$231.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$225.16
|
|
|
PLMT NEPHROURETERAL CATHETER(T
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761T2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.80 |
| Max. Negotiated Rate |
$5,433.60 |
| Rate for Payer: Aetna Commercial |
$4,358.20
|
| Rate for Payer: Anthem Medicaid |
$1,946.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,414.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$2,830.00
|
| Rate for Payer: Cash Price |
$2,830.00
|
| Rate for Payer: Cigna Commercial |
$4,697.80
|
| Rate for Payer: First Health Commercial |
$5,377.00
|
| Rate for Payer: Humana Commercial |
$4,811.00
|
| Rate for Payer: Humana KY Medicaid |
$1,946.47
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,966.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,641.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,985.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,980.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,754.60
|
| Rate for Payer: PHCS Commercial |
$5,433.60
|
| Rate for Payer: United Healthcare All Payer |
$4,980.80
|
|
|
PLMT NEPHROURETERAL CATHETER(T
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761T2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.80 |
| Max. Negotiated Rate |
$5,433.60 |
| Rate for Payer: Aetna Commercial |
$4,358.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,414.80
|
| Rate for Payer: Cash Price |
$2,830.00
|
| Rate for Payer: Cigna Commercial |
$4,697.80
|
| Rate for Payer: First Health Commercial |
$5,377.00
|
| Rate for Payer: Humana Commercial |
$4,811.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,641.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,980.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,754.60
|
| Rate for Payer: PHCS Commercial |
$5,433.60
|
| Rate for Payer: United Healthcare All Payer |
$4,980.80
|
|
|
PLMT URETERAL STENT PRQ
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
76102757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.98 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$178.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$365.04
|
| Rate for Payer: Humana Medicaid |
$178.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.23
|
| Rate for Payer: Molina Healthcare Passport |
$178.66
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.45
|
|
|
PLMT URETERAL STENT PRQ
|
Professional
|
Both
|
$7,217.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$7,217.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$293.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,217.00
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cigna Commercial |
$599.18
|
| Rate for Payer: Humana Medicaid |
$293.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.00
|
| Rate for Payer: Molina Healthcare Passport |
$293.14
|
| Rate for Payer: Multiplan PHCS |
$4,330.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,051.90
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.07
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
76102757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Humana KY Medicaid |
$357.66
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$361.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.40
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
OP
|
$7,217.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$938.21 |
| Max. Negotiated Rate |
$6,928.32 |
| Rate for Payer: Aetna Commercial |
$5,557.09
|
| Rate for Payer: Anthem Medicaid |
$2,481.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,629.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cigna Commercial |
$5,990.11
|
| Rate for Payer: First Health Commercial |
$6,856.15
|
| Rate for Payer: Humana Commercial |
$6,134.45
|
| Rate for Payer: Humana KY Medicaid |
$2,481.93
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,507.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,917.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,350.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,412.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.27
|
| Rate for Payer: PHCS Commercial |
$6,928.32
|
| Rate for Payer: United Healthcare All Payer |
$6,350.96
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$938.21 |
| Max. Negotiated Rate |
$6,928.32 |
| Rate for Payer: Aetna Commercial |
$5,557.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,629.26
|
| Rate for Payer: Cash Price |
$3,608.50
|
| Rate for Payer: Cigna Commercial |
$5,990.11
|
| Rate for Payer: First Health Commercial |
$6,856.15
|
| Rate for Payer: Humana Commercial |
$6,134.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,917.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,326.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,350.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,412.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,237.27
|
| Rate for Payer: PHCS Commercial |
$6,928.32
|
| Rate for Payer: United Healthcare All Payer |
$6,350.96
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
76102757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.20 |
| Max. Negotiated Rate |
$998.40 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$863.20
|
| Rate for Payer: First Health Commercial |
$988.00
|
| Rate for Payer: Humana Commercial |
$884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$852.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$767.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$915.20
|
| Rate for Payer: Ohio Health Group HMO |
$780.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.40
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
PLMT URETERAL STENT PRQ (P
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
761P2778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$1,355.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$293.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,355.00
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$599.18
|
| Rate for Payer: Humana Medicaid |
$293.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.00
|
| Rate for Payer: Molina Healthcare Passport |
$293.14
|
| Rate for Payer: Multiplan PHCS |
$813.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$948.50
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.07
|
|
|
PLMT URETERAL STENT PRQ (P
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
761P2757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.98 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$178.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$365.04
|
| Rate for Payer: Humana Medicaid |
$178.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.23
|
| Rate for Payer: Molina Healthcare Passport |
$178.66
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.45
|
|
|
PLMT URETERAL STENT PRQ (T
|
Facility
|
IP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
761T2778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.06 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,758.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,817.22
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
