|
BIPAP 1ST DAY(T
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
410T0080
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
|
BIPOLAR PACE CATH 5FR FLO DIRC
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
BIPOLAR PACE CATH 5FR FLO DIRC
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
BISACODYL 10 MG SUPPO 10MG/1EA
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 71399846002
|
| Hospital Charge Code |
25000339
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
|
|
BISACODYL 10 MG SUPPO 10MG/1EA
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 71399846002
|
| Hospital Charge Code |
25000339
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
BISMATROL 30ML ORAL SUSP
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 1490003908
|
| Hospital Charge Code |
25002896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
BISMATROL 30ML ORAL SUSP
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 1490003908
|
| Hospital Charge Code |
25002896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.45
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
BIVIGAM 500MG [10% 5GM] VIAL
|
Facility
|
OP
|
$3,624.25
|
|
|
Service Code
|
HCPCS J1556
|
| Hospital Charge Code |
25002081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$3,479.28 |
| Rate for Payer: Aetna Commercial |
$2,790.67
|
| Rate for Payer: Anthem Medicaid |
$1,246.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$72.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$102.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$98.50
|
| Rate for Payer: Cash Price |
$1,812.12
|
| Rate for Payer: Cash Price |
$1,812.12
|
| Rate for Payer: Cigna Commercial |
$3,008.13
|
| Rate for Payer: First Health Commercial |
$3,443.04
|
| Rate for Payer: Humana Commercial |
$3,080.61
|
| Rate for Payer: Humana KY Medicaid |
$1,246.38
|
| Rate for Payer: Humana Medicare Advantage |
$72.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,259.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,271.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,189.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.52
|
| Rate for Payer: PHCS Commercial |
$3,479.28
|
| Rate for Payer: United Healthcare All Payer |
$3,189.34
|
|
|
BIVIGAM 500MG [10% 5GM] VIAL
|
Facility
|
IP
|
$3,624.25
|
|
|
Service Code
|
HCPCS J1556
|
| Hospital Charge Code |
25002081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$471.15 |
| Max. Negotiated Rate |
$3,479.28 |
| Rate for Payer: Aetna Commercial |
$2,790.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.92
|
| Rate for Payer: Cash Price |
$1,812.12
|
| Rate for Payer: Cigna Commercial |
$3,008.13
|
| Rate for Payer: First Health Commercial |
$3,443.04
|
| Rate for Payer: Humana Commercial |
$3,080.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,189.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.52
|
| Rate for Payer: PHCS Commercial |
$3,479.28
|
| Rate for Payer: United Healthcare All Payer |
$3,189.34
|
|
|
BKA TIBIA FIBULA
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
76100958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
BKA TIBIA FIBULA
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
76100958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
BKA TIBIA FIBULA
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
76100958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.79 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$937.47
|
| Rate for Payer: Anthem Medicaid |
$460.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,052.26
|
| Rate for Payer: Healthspan PPO |
$849.15
|
| Rate for Payer: Humana Medicaid |
$460.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.01
|
| Rate for Payer: Molina Healthcare Passport |
$460.79
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.40
|
|
|
BKA TIBIA FIBULA(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27882
|
| Hospital Charge Code |
761P0958
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.79 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$937.47
|
| Rate for Payer: Anthem Medicaid |
$460.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,052.26
|
| Rate for Payer: Healthspan PPO |
$849.15
|
| Rate for Payer: Humana Medicaid |
$460.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.01
|
| Rate for Payer: Molina Healthcare Passport |
$460.79
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.40
|
|
|
BLA CTX-M GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
BLA CTX-M GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$827.01
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$590.72 |
| Max. Negotiated Rate |
$827.01 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Professional
|
Both
|
$1,646.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$1,646.00 |
| Rate for Payer: Aetna Commercial |
$137.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$64.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,646.00
|
| Rate for Payer: Cash Price |
$823.00
|
| Rate for Payer: Cash Price |
$823.00
|
| Rate for Payer: Cigna Commercial |
$182.49
|
| Rate for Payer: Healthspan PPO |
$149.11
|
| Rate for Payer: Humana Medicaid |
$64.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.06
|
| Rate for Payer: Molina Healthcare Passport |
$64.76
|
| Rate for Payer: Multiplan PHCS |
$987.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,152.20
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.41
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.98 |
| Max. Negotiated Rate |
$1,580.16 |
| Rate for Payer: Aetna Commercial |
$1,267.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,283.88
|
| Rate for Payer: Cash Price |
$823.00
|
| Rate for Payer: Cigna Commercial |
$1,366.18
|
| Rate for Payer: First Health Commercial |
$1,563.70
|
| Rate for Payer: Humana Commercial |
$1,399.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,349.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,214.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$493.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,448.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,234.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$510.26
|
| Rate for Payer: PHCS Commercial |
$1,580.16
|
| Rate for Payer: United Healthcare All Payer |
$1,448.48
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.98 |
| Max. Negotiated Rate |
$1,580.16 |
| Rate for Payer: Aetna Commercial |
$1,267.42
|
| Rate for Payer: Anthem Medicaid |
$566.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,283.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$823.00
|
| Rate for Payer: Cash Price |
$823.00
|
| Rate for Payer: Cigna Commercial |
$1,366.18
|
| Rate for Payer: First Health Commercial |
$1,563.70
|
| Rate for Payer: Humana Commercial |
$1,399.10
|
| Rate for Payer: Humana KY Medicaid |
$566.06
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$571.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,349.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,214.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$577.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,448.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,234.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$329.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$510.26
|
| Rate for Payer: PHCS Commercial |
$1,580.16
|
| Rate for Payer: United Healthcare All Payer |
$1,448.48
|
|
|
BLADDER INSTILL CHEMO AGENT (P
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761P2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$137.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$64.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$336.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$182.49
|
| Rate for Payer: Healthspan PPO |
$149.11
|
| Rate for Payer: Humana Medicaid |
$64.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.06
|
| Rate for Payer: Molina Healthcare Passport |
$64.76
|
| Rate for Payer: Multiplan PHCS |
$201.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$235.20
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.41
|
|
|
BLADDER INSTILL CHEMO AGENT (T
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761T2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$1,257.60 |
| Rate for Payer: Aetna Commercial |
$1,008.70
|
| Rate for Payer: Anthem Medicaid |
$450.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,021.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cigna Commercial |
$1,087.30
|
| Rate for Payer: First Health Commercial |
$1,244.50
|
| Rate for Payer: Humana Commercial |
$1,113.50
|
| Rate for Payer: Humana KY Medicaid |
$450.51
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$455.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,074.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$966.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$459.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,152.80
|
| Rate for Payer: Ohio Health Group HMO |
$982.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.10
|
| Rate for Payer: PHCS Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Payer |
$1,152.80
|
|
|
BLADDER INSTILL CHEMO AGENT (T
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761T2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$1,257.60 |
| Rate for Payer: Aetna Commercial |
$1,008.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,021.80
|
| Rate for Payer: Cash Price |
$655.00
|
| Rate for Payer: Cigna Commercial |
$1,087.30
|
| Rate for Payer: First Health Commercial |
$1,244.50
|
| Rate for Payer: Humana Commercial |
$1,113.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,074.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$966.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,152.80
|
| Rate for Payer: Ohio Health Group HMO |
$982.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$262.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$170.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$406.10
|
| Rate for Payer: PHCS Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Payer |
$1,152.80
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
45000278
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
45000278
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
761P2064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.61
|
| Rate for Payer: Anthem Medicaid |
$29.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$137.18
|
| Rate for Payer: Healthspan PPO |
$109.08
|
| Rate for Payer: Humana Medicaid |
$29.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.85
|
| Rate for Payer: Molina Healthcare Passport |
$29.26
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$26.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.55
|
|
