|
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 |
$1,052.26 |
| Rate for Payer: Aetna Commercial |
$937.47
|
| Rate for Payer: Ambetter Exchange |
$560.47
|
| Rate for Payer: Anthem Medicaid |
$460.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$560.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$672.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$560.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.47
|
| 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 |
$728.61
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$560.47
|
|
|
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 |
$1,052.26 |
| Rate for Payer: Aetna Commercial |
$937.47
|
| Rate for Payer: Ambetter Exchange |
$560.47
|
| Rate for Payer: Anthem Medicaid |
$460.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$560.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$672.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$560.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.47
|
| 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 |
$728.61
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$560.47
|
|
|
BLA CTX-M GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
BLA CTX-M GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| 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 |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING RETENTION TIME)
|
Facility
|
OP
|
$863.42
|
|
|
Service Code
|
CPT 51720
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.73 |
| Max. Negotiated Rate |
$863.42 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Professional
|
Both
|
$1,731.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$1,038.60 |
| Rate for Payer: Aetna Commercial |
$137.77
|
| Rate for Payer: Ambetter Exchange |
$41.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$70.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.90
|
| Rate for Payer: Cash Price |
$865.50
|
| Rate for Payer: Cash Price |
$865.50
|
| Rate for Payer: Cigna Commercial |
$182.49
|
| Rate for Payer: Healthspan PPO |
$149.11
|
| Rate for Payer: Humana Medicaid |
$70.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.22
|
| Rate for Payer: Molina Healthcare Passport |
$70.80
|
| Rate for Payer: Multiplan PHCS |
$1,038.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.05
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.58
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.29 |
| Max. Negotiated Rate |
$1,661.76 |
| Rate for Payer: Aetna Commercial |
$1,332.87
|
| Rate for Payer: Anthem Medicaid |
$595.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Cash Price |
$865.50
|
| Rate for Payer: Cash Price |
$865.50
|
| Rate for Payer: Cigna Commercial |
$1,436.73
|
| Rate for Payer: First Health Commercial |
$1,644.45
|
| Rate for Payer: Humana Commercial |
$1,471.35
|
| Rate for Payer: Humana KY Medicaid |
$595.29
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Kentucky WC Medicaid |
$601.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,505.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,194.39
|
| Rate for Payer: PHCS Commercial |
$1,661.76
|
| Rate for Payer: United Healthcare All Payer |
$1,523.28
|
|
|
BLADDER INSTILL CHEMO AGENT
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.30 |
| Max. Negotiated Rate |
$1,661.76 |
| Rate for Payer: Aetna Commercial |
$1,332.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.18
|
| Rate for Payer: Cash Price |
$865.50
|
| Rate for Payer: Cigna Commercial |
$1,436.73
|
| Rate for Payer: First Health Commercial |
$1,644.45
|
| Rate for Payer: Humana Commercial |
$1,471.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,505.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,194.39
|
| Rate for Payer: PHCS Commercial |
$1,661.76
|
| Rate for Payer: United Healthcare All Payer |
$1,523.28
|
|
|
BLADDER INSTILL CHEMO AGENT (P
|
Professional
|
Both
|
$336.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761P2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$137.77
|
| Rate for Payer: Ambetter Exchange |
$41.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.95
|
| Rate for Payer: Anthem Medicaid |
$70.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.90
|
| 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 |
$70.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$41.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.22
|
| Rate for Payer: Molina Healthcare Passport |
$70.80
|
| Rate for Payer: Multiplan PHCS |
$201.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.05
|
| Rate for Payer: UHCCP Medicaid |
$46.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.58
|
|
|
BLADDER INSTILL CHEMO AGENT (T
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761T2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.50 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,074.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,088.10
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,157.85
|
| Rate for Payer: First Health Commercial |
$1,325.25
|
| Rate for Payer: Humana Commercial |
$1,185.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,029.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,227.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.55
|
| Rate for Payer: PHCS Commercial |
$1,339.20
|
| Rate for Payer: United Healthcare All Payer |
$1,227.60
|
|
|
BLADDER INSTILL CHEMO AGENT (T
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
761T2792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.74 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,074.15
|
| Rate for Payer: Anthem Medicaid |
$479.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,088.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,157.85
|
| Rate for Payer: First Health Commercial |
$1,325.25
|
| Rate for Payer: Humana Commercial |
$1,185.75
|
| Rate for Payer: Humana KY Medicaid |
$479.74
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Kentucky WC Medicaid |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,029.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$489.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,227.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,213.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$962.55
|
| Rate for Payer: PHCS Commercial |
$1,339.20
|
| Rate for Payer: United Healthcare All Payer |
$1,227.60
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
45000278
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem Medicaid |
$196.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Humana KY Medicaid |
$196.71
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$198.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
761T2064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
45000278
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
761T2064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$549.12 |
| Rate for Payer: Aetna Commercial |
$440.44
|
| Rate for Payer: Anthem Medicaid |
$196.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cigna Commercial |
$474.76
|
| Rate for Payer: First Health Commercial |
$543.40
|
| Rate for Payer: Humana Commercial |
$486.20
|
| Rate for Payer: Humana KY Medicaid |
$196.71
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$198.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.36
|
| Rate for Payer: Ohio Health Group HMO |
$429.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$394.68
|
| Rate for Payer: PHCS Commercial |
$549.12
|
| Rate for Payer: United Healthcare All Payer |
$503.36
|
|
|
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 |
$150.00 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$28.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.61
|
| Rate for Payer: Anthem Medicaid |
$32.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.88
|
| 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 |
$32.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.85
|
| Rate for Payer: Molina Healthcare Passport |
$32.21
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$26.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.23
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
76102064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$789.12 |
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.18
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
76102064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$789.12 |
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem Medicaid |
$282.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Humana KY Medicaid |
$282.69
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$285.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.18
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
|
|
BLADD IRIGSMPLE LAVAGEINSTILAT
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
76102064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$493.20 |
| Rate for Payer: Aetna Commercial |
$73.27
|
| Rate for Payer: Ambetter Exchange |
$28.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$25.61
|
| Rate for Payer: Anthem Medicaid |
$32.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.88
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$137.18
|
| Rate for Payer: Healthspan PPO |
$109.08
|
| Rate for Payer: Humana Medicaid |
$32.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.85
|
| Rate for Payer: Molina Healthcare Passport |
$32.21
|
| Rate for Payer: Multiplan PHCS |
$493.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$26.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.23
|
|
|
BLADE INSTRATEK TRIANGLE ST
|
Facility
|
OP
|
$2,046.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.90 |
| Max. Negotiated Rate |
$1,964.47 |
| Rate for Payer: Aetna Commercial |
$1,575.67
|
| Rate for Payer: Anthem Medicaid |
$703.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.13
|
| Rate for Payer: Cash Price |
$1,023.16
|
| Rate for Payer: Cigna Commercial |
$1,698.45
|
| Rate for Payer: First Health Commercial |
$1,944.00
|
| Rate for Payer: Humana Commercial |
$1,739.37
|
| Rate for Payer: Humana KY Medicaid |
$703.73
|
| Rate for Payer: Kentucky WC Medicaid |
$710.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,780.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.96
|
| Rate for Payer: PHCS Commercial |
$1,964.47
|
| Rate for Payer: United Healthcare All Payer |
$1,800.76
|
|
|
BLADE INSTRATEK TRIANGLE ST
|
Facility
|
IP
|
$2,046.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.90 |
| Max. Negotiated Rate |
$1,964.47 |
| Rate for Payer: Aetna Commercial |
$1,575.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,596.13
|
| Rate for Payer: Cash Price |
$1,023.16
|
| Rate for Payer: Cigna Commercial |
$1,698.45
|
| Rate for Payer: First Health Commercial |
$1,944.00
|
| Rate for Payer: Humana Commercial |
$1,739.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,510.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,637.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,780.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.96
|
| Rate for Payer: PHCS Commercial |
$1,964.47
|
| Rate for Payer: United Healthcare All Payer |
$1,800.76
|
|
|
BLADE RAD OSTEO SZ16
|
Facility
|
IP
|
$1,801.41
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.42 |
| Max. Negotiated Rate |
$1,729.35 |
| Rate for Payer: Aetna Commercial |
$1,387.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.10
|
| Rate for Payer: Cash Price |
$900.70
|
| Rate for Payer: Cigna Commercial |
$1,495.17
|
| Rate for Payer: First Health Commercial |
$1,711.34
|
| Rate for Payer: Humana Commercial |
$1,531.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.97
|
| Rate for Payer: PHCS Commercial |
$1,729.35
|
| Rate for Payer: United Healthcare All Payer |
$1,585.24
|
|
|
BLADE RAD OSTEO SZ16
|
Facility
|
OP
|
$1,801.41
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.42 |
| Max. Negotiated Rate |
$1,729.35 |
| Rate for Payer: Aetna Commercial |
$1,387.09
|
| Rate for Payer: Anthem Medicaid |
$619.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.10
|
| Rate for Payer: Cash Price |
$900.70
|
| Rate for Payer: Cigna Commercial |
$1,495.17
|
| Rate for Payer: First Health Commercial |
$1,711.34
|
| Rate for Payer: Humana Commercial |
$1,531.20
|
| Rate for Payer: Humana KY Medicaid |
$619.50
|
| Rate for Payer: Kentucky WC Medicaid |
$625.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.97
|
| Rate for Payer: PHCS Commercial |
$1,729.35
|
| Rate for Payer: United Healthcare All Payer |
$1,585.24
|
|
|
BLADE STRYKER DUAL CUT
|
Facility
|
IP
|
$505.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$485.38 |
| Rate for Payer: Aetna Commercial |
$389.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.37
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cigna Commercial |
$419.65
|
| Rate for Payer: First Health Commercial |
$480.32
|
| Rate for Payer: Humana Commercial |
$429.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.93
|
| Rate for Payer: Ohio Health Group HMO |
$379.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.86
|
| Rate for Payer: PHCS Commercial |
$485.38
|
| Rate for Payer: United Healthcare All Payer |
$444.93
|
|
|
BLADE STRYKER DUAL CUT
|
Facility
|
OP
|
$505.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$485.38 |
| Rate for Payer: Aetna Commercial |
$389.31
|
| Rate for Payer: Anthem Medicaid |
$173.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.37
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cigna Commercial |
$419.65
|
| Rate for Payer: First Health Commercial |
$480.32
|
| Rate for Payer: Humana Commercial |
$429.76
|
| Rate for Payer: Humana KY Medicaid |
$173.88
|
| Rate for Payer: Kentucky WC Medicaid |
$175.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.93
|
| Rate for Payer: Ohio Health Group HMO |
$379.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.86
|
| Rate for Payer: PHCS Commercial |
$485.38
|
| Rate for Payer: United Healthcare All Payer |
$444.93
|
|
