|
PLMT NEPHROURETERAL CATHETER(T
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761T2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,698.00 |
| 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 |
$4,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,924.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.40
|
| Rate for Payer: PHCS Commercial |
$5,433.60
|
| Rate for Payer: United Healthcare All Payer |
$4,980.80
|
|
|
PLMT NEPHROURETERAL CATHETER(T
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
HCPCS 50433
|
| Hospital Charge Code |
761T2751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,946.47 |
| 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 |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,414.80
|
| 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 |
$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 |
$3,186.78
|
| 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 |
$3,824.14
|
| 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 |
$4,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,924.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.40
|
| 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 |
$807.40 |
| Rate for Payer: Ambetter Exchange |
$189.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$791.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.04
|
| 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 |
$791.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$807.40
|
| Rate for Payer: Molina Healthcare Passport |
$791.57
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.96
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$799.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.20
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
76102757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.00 |
| 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 |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| Rate for Payer: PHCS Commercial |
$998.40
|
| Rate for Payer: United Healthcare All Payer |
$915.20
|
|
|
PLMT URETERAL STENT PRQ
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$4,558.80 |
| Rate for Payer: Ambetter Exchange |
$317.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$1,068.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$380.63
|
| Rate for Payer: Cash Price |
$3,799.00
|
| Rate for Payer: Cash Price |
$3,799.00
|
| Rate for Payer: Cigna Commercial |
$599.18
|
| Rate for Payer: Humana Medicaid |
$1,068.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,089.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,068.01
|
| Rate for Payer: Multiplan PHCS |
$4,558.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$412.35
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,078.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.19
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
OP
|
$7,598.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,612.95 |
| Max. Negotiated Rate |
$7,294.08 |
| Rate for Payer: Aetna Commercial |
$5,850.46
|
| Rate for Payer: Anthem Medicaid |
$2,612.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.44
|
| 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 |
$3,799.00
|
| Rate for Payer: Cash Price |
$3,799.00
|
| Rate for Payer: Cigna Commercial |
$6,306.34
|
| Rate for Payer: First Health Commercial |
$7,218.10
|
| Rate for Payer: Humana Commercial |
$6,458.30
|
| Rate for Payer: Humana KY Medicaid |
$2,612.95
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,639.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,665.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,610.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,242.62
|
| Rate for Payer: PHCS Commercial |
$7,294.08
|
| Rate for Payer: United Healthcare All Payer |
$6,686.24
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
IP
|
$7,598.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,279.40 |
| Max. Negotiated Rate |
$7,294.08 |
| Rate for Payer: Aetna Commercial |
$5,850.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,926.44
|
| Rate for Payer: Cash Price |
$3,799.00
|
| Rate for Payer: Cigna Commercial |
$6,306.34
|
| Rate for Payer: First Health Commercial |
$7,218.10
|
| Rate for Payer: Humana Commercial |
$6,458.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,230.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,607.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,279.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,686.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,698.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,078.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,610.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,242.62
|
| Rate for Payer: PHCS Commercial |
$7,294.08
|
| Rate for Payer: United Healthcare All Payer |
$6,686.24
|
|
|
PLMT URETERAL STENT PRQ
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
HCPCS 50693
|
| Hospital Charge Code |
76102757
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.66 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$800.80
|
| Rate for Payer: Anthem Medicaid |
$357.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$811.20
|
| 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 |
$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 |
$3,186.78
|
| 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 |
$3,824.14
|
| 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 |
$832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$717.60
|
| 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 |
$1,089.37 |
| Rate for Payer: Ambetter Exchange |
$317.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$1,068.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$380.63
|
| 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 |
$1,068.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,089.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,068.01
|
| Rate for Payer: Multiplan PHCS |
$813.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$412.35
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,078.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.19
|
|
|
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 |
$807.40 |
| Rate for Payer: Ambetter Exchange |
$189.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.98
|
| Rate for Payer: Anthem Medicaid |
$791.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.04
|
| 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 |
$791.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$298.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$807.40
|
| Rate for Payer: Molina Healthcare Passport |
$791.57
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.96
|
| Rate for Payer: UHCCP Medicaid |
$185.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$799.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.20
|
|
|
PLMT URETERAL STENT PRQ (T
|
Facility
|
OP
|
$6,243.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
761T2778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,146.97 |
| Max. Negotiated Rate |
$5,993.28 |
| Rate for Payer: Aetna Commercial |
$4,807.11
|
| Rate for Payer: Anthem Medicaid |
$2,146.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,869.54
|
| 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 |
$3,121.50
|
| Rate for Payer: Cash Price |
$3,121.50
|
| Rate for Payer: Cigna Commercial |
$5,181.69
|
| Rate for Payer: First Health Commercial |
$5,930.85
|
| Rate for Payer: Humana Commercial |
$5,306.55
|
| Rate for Payer: Humana KY Medicaid |
$2,146.97
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,168.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,119.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,607.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,190.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,493.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,682.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,994.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,431.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,307.67
|
| Rate for Payer: PHCS Commercial |
$5,993.28
|
| Rate for Payer: United Healthcare All Payer |
$5,493.84
|
|
|
PLMT URETERAL STENT PRQ (T
|
Facility
|
IP
|
$6,243.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
761T2778
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,872.90 |
| Max. Negotiated Rate |
$5,993.28 |
| Rate for Payer: Aetna Commercial |
$4,807.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,869.54
|
| Rate for Payer: Cash Price |
$3,121.50
|
| Rate for Payer: Cigna Commercial |
$5,181.69
|
| Rate for Payer: First Health Commercial |
$5,930.85
|
| Rate for Payer: Humana Commercial |
$5,306.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,119.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,607.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,872.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,493.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,682.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,994.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,431.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,307.67
|
| Rate for Payer: PHCS Commercial |
$5,993.28
|
| Rate for Payer: United Healthcare All Payer |
$5,493.84
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Ambetter Exchange |
$301.86
|
| Rate for Payer: Anthem Medicaid |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.23
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$595.80
|
| Rate for Payer: Humana Medicaid |
$260.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.73
|
| Rate for Payer: Molina Healthcare Passport |
$260.52
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.42
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.86
|
|
|
PLMT XTN PROSTH EVASC RPR
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
76101350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
PLMT XTN PROSTH EVASC RPR(P
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 34709
|
| Hospital Charge Code |
761P1350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Ambetter Exchange |
$301.86
|
| Rate for Payer: Anthem Medicaid |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$301.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$301.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$362.23
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$595.80
|
| Rate for Payer: Humana Medicaid |
$260.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$301.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$265.73
|
| Rate for Payer: Molina Healthcare Passport |
$260.52
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.42
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$301.86
|
|
|
PLT APHERESIS LEUKOREDUCED IRR
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
38000013
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$413.10 |
| Max. Negotiated Rate |
$1,321.92 |
| Rate for Payer: Aetna Commercial |
$1,060.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,074.06
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: First Health Commercial |
$1,308.15
|
| Rate for Payer: Humana Commercial |
$1,170.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,129.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,016.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,211.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,032.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$950.13
|
| Rate for Payer: PHCS Commercial |
$1,321.92
|
| Rate for Payer: United Healthcare All Payer |
$1,211.76
|
|
|
PLT APHERESIS LEUKOREDUCED IRR
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
38000013
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$473.55 |
| Max. Negotiated Rate |
$1,321.92 |
| Rate for Payer: Aetna Commercial |
$1,060.29
|
| Rate for Payer: Anthem Medicaid |
$473.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,074.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$874.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$842.80
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Cigna Commercial |
$1,142.91
|
| Rate for Payer: First Health Commercial |
$1,308.15
|
| Rate for Payer: Humana Commercial |
$1,170.45
|
| Rate for Payer: Humana KY Medicaid |
$473.55
|
| Rate for Payer: Humana Medicare Advantage |
$624.30
|
| Rate for Payer: Kentucky WC Medicaid |
$478.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,129.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,016.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$749.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$483.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,211.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,032.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$950.13
|
| Rate for Payer: PHCS Commercial |
$1,321.92
|
| Rate for Payer: United Healthcare All Payer |
$1,211.76
|
|
|
PLT OR CRYO POOLING EA UNIT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
30001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.63 |
| Max. Negotiated Rate |
$221.66 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
PLT OR CRYO POOLING EA UNIT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS 86965
|
| Hospital Charge Code |
30001241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.10 |
| Max. Negotiated Rate |
$217.92 |
| Rate for Payer: Aetna Commercial |
$174.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.28
|
| Rate for Payer: Cash Price |
$113.50
|
| Rate for Payer: Cigna Commercial |
$188.41
|
| Rate for Payer: First Health Commercial |
$215.65
|
| Rate for Payer: Humana Commercial |
$192.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$167.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$199.76
|
| Rate for Payer: Ohio Health Group HMO |
$170.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.63
|
| Rate for Payer: PHCS Commercial |
$217.92
|
| Rate for Payer: United Healthcare All Payer |
$199.76
|
|
|
PLUG CANC W/CARTILAGE 10MM
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLUG CANC W/CARTILAGE 10MM
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLUG CANC W/CARTILAGE 11MM
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLUG CANC W/CARTILAGE 11MM
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLUG CPS ANCHOR 10MM
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
