|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
76102064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$755.52 |
| Rate for Payer: Aetna Commercial |
$605.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.86
|
| Rate for Payer: Cash Price |
$393.50
|
| Rate for Payer: Cigna Commercial |
$653.21
|
| Rate for Payer: First Health Commercial |
$747.65
|
| Rate for Payer: Humana Commercial |
$668.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$692.56
|
| Rate for Payer: Ohio Health Group HMO |
$590.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.97
|
| Rate for Payer: PHCS Commercial |
$755.52
|
| Rate for Payer: United Healthcare All Payer |
$692.56
|
|
|
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
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
761T2064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
761T2064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$413.49
|
| Rate for Payer: Anthem Medicaid |
$184.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cash Price |
$268.50
|
| Rate for Payer: Cigna Commercial |
$445.71
|
| Rate for Payer: First Health Commercial |
$510.15
|
| Rate for Payer: Humana Commercial |
$456.45
|
| Rate for Payer: Humana KY Medicaid |
$184.67
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$186.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$440.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$396.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$472.56
|
| Rate for Payer: Ohio Health Group HMO |
$402.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$107.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.47
|
| Rate for Payer: PHCS Commercial |
$515.52
|
| Rate for Payer: United Healthcare All Payer |
$472.56
|
|
|
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
|
|
|
BLADE INSTRATEK TRIANGLE ST
|
Facility
|
IP
|
$2,037.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.86 |
| Max. Negotiated Rate |
$1,955.90 |
| Rate for Payer: Aetna Commercial |
$1,568.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,018.70
|
| Rate for Payer: Cigna Commercial |
$1,691.04
|
| Rate for Payer: First Health Commercial |
$1,935.53
|
| Rate for Payer: Humana Commercial |
$1,731.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,528.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.59
|
| Rate for Payer: PHCS Commercial |
$1,955.90
|
| Rate for Payer: United Healthcare All Payer |
$1,792.91
|
|
|
BLADE INSTRATEK TRIANGLE ST
|
Facility
|
OP
|
$2,037.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.86 |
| Max. Negotiated Rate |
$1,955.90 |
| Rate for Payer: Aetna Commercial |
$1,568.80
|
| Rate for Payer: Anthem Medicaid |
$700.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,018.70
|
| Rate for Payer: Cigna Commercial |
$1,691.04
|
| Rate for Payer: First Health Commercial |
$1,935.53
|
| Rate for Payer: Humana Commercial |
$1,731.79
|
| Rate for Payer: Humana KY Medicaid |
$700.66
|
| Rate for Payer: Kentucky WC Medicaid |
$707.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.91
|
| Rate for Payer: Ohio Health Group HMO |
$1,528.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.59
|
| Rate for Payer: PHCS Commercial |
$1,955.90
|
| Rate for Payer: United Healthcare All Payer |
$1,792.91
|
|
|
BLADE QUAD 9MM
|
Facility
|
OP
|
$1,993.12
|
|
|
Service Code
|
HCPCS L2795
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.11 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna Commercial |
$1,534.70
|
| Rate for Payer: Anthem Medicaid |
$685.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.63
|
| Rate for Payer: Cash Price |
$996.56
|
| Rate for Payer: Cigna Commercial |
$1,654.29
|
| Rate for Payer: First Health Commercial |
$1,893.46
|
| Rate for Payer: Humana Commercial |
$1,694.15
|
| Rate for Payer: Humana KY Medicaid |
$685.43
|
| Rate for Payer: Kentucky WC Medicaid |
$692.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.87
|
| Rate for Payer: PHCS Commercial |
$1,913.40
|
| Rate for Payer: United Healthcare All Payer |
$1,753.95
|
|
|
BLADE QUAD 9MM
|
Facility
|
IP
|
$1,993.12
|
|
|
Service Code
|
HCPCS L2795
|
| Hospital Charge Code |
27000024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.11 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Aetna Commercial |
$1,534.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.63
|
| Rate for Payer: Cash Price |
$996.56
|
| Rate for Payer: Cigna Commercial |
$1,654.29
|
| Rate for Payer: First Health Commercial |
$1,893.46
|
| Rate for Payer: Humana Commercial |
$1,694.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.87
|
| Rate for Payer: PHCS Commercial |
$1,913.40
|
| Rate for Payer: United Healthcare All Payer |
$1,753.95
|
|
|
BLADE RAD OSTEO SZ16
|
Facility
|
IP
|
$1,811.83
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.54 |
| Max. Negotiated Rate |
$1,739.36 |
| Rate for Payer: Aetna Commercial |
$1,395.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.23
|
| Rate for Payer: Cash Price |
$905.91
|
| Rate for Payer: Cigna Commercial |
$1,503.82
|
| Rate for Payer: First Health Commercial |
$1,721.24
|
| Rate for Payer: Humana Commercial |
$1,540.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,358.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.67
|
| Rate for Payer: PHCS Commercial |
$1,739.36
|
| Rate for Payer: United Healthcare All Payer |
$1,594.41
|
|
|
BLADE RAD OSTEO SZ16
|
Facility
|
OP
|
$1,811.83
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.54 |
| Max. Negotiated Rate |
$1,739.36 |
| Rate for Payer: Aetna Commercial |
$1,395.11
|
| Rate for Payer: Anthem Medicaid |
$623.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,413.23
|
| Rate for Payer: Cash Price |
$905.91
|
| Rate for Payer: Cigna Commercial |
$1,503.82
|
| Rate for Payer: First Health Commercial |
$1,721.24
|
| Rate for Payer: Humana Commercial |
$1,540.06
|
| Rate for Payer: Humana KY Medicaid |
$623.09
|
| Rate for Payer: Kentucky WC Medicaid |
$629.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,485.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$635.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,594.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,358.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$235.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$561.67
|
| Rate for Payer: PHCS Commercial |
$1,739.36
|
| Rate for Payer: United Healthcare All Payer |
$1,594.41
|
|
|
BLADE STRYKER DUAL CUT
|
Facility
|
IP
|
$500.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$385.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.31
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$415.33
|
| Rate for Payer: First Health Commercial |
$475.38
|
| Rate for Payer: Humana Commercial |
$425.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.35
|
| Rate for Payer: Ohio Health Group HMO |
$375.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.12
|
| Rate for Payer: PHCS Commercial |
$480.38
|
| Rate for Payer: United Healthcare All Payer |
$440.35
|
|
|
BLADE STRYKER DUAL CUT
|
Facility
|
OP
|
$500.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$385.31
|
| Rate for Payer: Anthem Medicaid |
$172.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.31
|
| Rate for Payer: Cash Price |
$250.20
|
| Rate for Payer: Cigna Commercial |
$415.33
|
| Rate for Payer: First Health Commercial |
$475.38
|
| Rate for Payer: Humana Commercial |
$425.34
|
| Rate for Payer: Humana KY Medicaid |
$172.09
|
| Rate for Payer: Kentucky WC Medicaid |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.35
|
| Rate for Payer: Ohio Health Group HMO |
$375.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.12
|
| Rate for Payer: PHCS Commercial |
$480.38
|
| Rate for Payer: United Healthcare All Payer |
$440.35
|
|
|
BLA IMP BLD POS QL PRB MAG
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001287
|
|
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
|
|
|
BLA IMP BLD POS QL PRB MAG
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001287
|
|
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
|
|
|
BLAKEMORE TUBE INSERTION
|
Facility
|
OP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
45000339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem Medicaid |
$1,465.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Humana KY Medicaid |
$1,465.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
BLAKEMORE TUBE INSERTION
|
Facility
|
IP
|
$4,260.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
45000339
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
BLA KPC GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001289
|
|
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
|
|
|
BLA KPC GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001289
|
|
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 NDM ISLT QL PCR
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001290
|
|
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 NDM ISLT QL PCR
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001290
|
|
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
|
|
|
BLA OXA BLD POS QL PRB MAG
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001295
|
|
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 OXA BLD POS QL PRB MAG
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001295
|
|
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
|
|
|
BLA VIM BLD POS QL PRB MAG
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001308
|
|
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
|
|
|
BLA VIM BLD POS QL PRB MAG
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001308
|
|
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
|
|
