|
CAUTERY/ABLATION
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CAUTERY/ABLATION
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.99 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.72
|
| Rate for Payer: Anthem Medicaid |
$85.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$253.74
|
| Rate for Payer: Healthspan PPO |
$328.32
|
| Rate for Payer: Humana Medicaid |
$85.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.71
|
| Rate for Payer: Molina Healthcare Passport |
$85.99
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$111.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.85
|
|
|
CAUTERY/ABLATION
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CAUTERY & ABLATION(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
761P1136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$181.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.77
|
| Rate for Payer: Anthem Medicaid |
$37.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$297.80
|
| Rate for Payer: Healthspan PPO |
$251.28
|
| Rate for Payer: Humana Medicaid |
$37.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.20
|
| Rate for Payer: Molina Healthcare Passport |
$37.45
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$83.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.82
|
|
|
CAUTERY/ABLATION(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
761P1137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.99 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$105.72
|
| Rate for Payer: Anthem Medicaid |
$85.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$253.74
|
| Rate for Payer: Healthspan PPO |
$328.32
|
| Rate for Payer: Humana Medicaid |
$85.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.71
|
| Rate for Payer: Molina Healthcare Passport |
$85.99
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$111.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.85
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Professional
|
Both
|
$3,893.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
76102200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.67 |
| Max. Negotiated Rate |
$3,893.00 |
| Rate for Payer: Aetna Commercial |
$176.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.67
|
| Rate for Payer: Anthem Medicaid |
$63.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,893.00
|
| Rate for Payer: Cash Price |
$1,946.50
|
| Rate for Payer: Cash Price |
$1,946.50
|
| Rate for Payer: Cigna Commercial |
$201.83
|
| Rate for Payer: Healthspan PPO |
$193.56
|
| Rate for Payer: Humana Medicaid |
$63.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.72
|
| Rate for Payer: Molina Healthcare Passport |
$63.45
|
| Rate for Payer: Multiplan PHCS |
$2,335.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,725.10
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.08
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
761P2200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.67 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$176.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.67
|
| Rate for Payer: Anthem Medicaid |
$63.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$201.83
|
| Rate for Payer: Healthspan PPO |
$193.56
|
| Rate for Payer: Humana Medicaid |
$63.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.72
|
| Rate for Payer: Molina Healthcare Passport |
$63.45
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.08
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
761T2200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,434.88 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Facility
|
OP
|
$3,893.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
76102200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.09 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Aetna Commercial |
$2,997.61
|
| Rate for Payer: Anthem Medicaid |
$1,338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,036.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$1,946.50
|
| Rate for Payer: Cash Price |
$1,946.50
|
| Rate for Payer: Cigna Commercial |
$3,231.19
|
| Rate for Payer: First Health Commercial |
$3,698.35
|
| Rate for Payer: Humana Commercial |
$3,309.05
|
| Rate for Payer: Humana KY Medicaid |
$1,338.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,365.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,425.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.83
|
| Rate for Payer: PHCS Commercial |
$3,737.28
|
| Rate for Payer: United Healthcare All Payer |
$3,425.84
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
761T2200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Humana KY Medicaid |
$1,230.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
CAUTERY OF CERVIXELEC OR THERM
|
Facility
|
IP
|
$3,893.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
76102200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.09 |
| Max. Negotiated Rate |
$3,737.28 |
| Rate for Payer: Aetna Commercial |
$2,997.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,036.54
|
| Rate for Payer: Cash Price |
$1,946.50
|
| Rate for Payer: Cigna Commercial |
$3,231.19
|
| Rate for Payer: First Health Commercial |
$3,698.35
|
| Rate for Payer: Humana Commercial |
$3,309.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,192.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,873.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,425.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.83
|
| Rate for Payer: PHCS Commercial |
$3,737.28
|
| Rate for Payer: United Healthcare All Payer |
$3,425.84
|
|
|
CAUTERY OF CERVIX; ELECTRO OR THERMAL
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 57510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
CBC W/DIFF
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$11.11
|
| Rate for Payer: Healthspan PPO |
$8.14
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.66
|
|
|
CBC W/DIFF
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
CBC W/DIFF
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$7.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$7.77
|
| Rate for Payer: Humana Medicare Advantage |
$7.77
|
| Rate for Payer: Kentucky WC Medicaid |
$7.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
CBC WITHOUT DIFF
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
CBC WITHOUT DIFF
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$10.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$9.22
|
| Rate for Payer: Healthspan PPO |
$6.78
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$46.20
|
| Rate for Payer: UHCCP Medicaid |
$23.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.88
|
|
|
CBC WITHOUT DIFF
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.46
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
CBL ASSBLY W/CERCRMP 1.8*635MM
|
Facility
|
OP
|
$4,190.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.73 |
| Max. Negotiated Rate |
$4,022.63 |
| Rate for Payer: Aetna Commercial |
$3,226.48
|
| Rate for Payer: Anthem Medicaid |
$1,441.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.39
|
| Rate for Payer: Cash Price |
$2,095.12
|
| Rate for Payer: Cigna Commercial |
$3,477.90
|
| Rate for Payer: First Health Commercial |
$3,980.73
|
| Rate for Payer: Humana Commercial |
$3,561.70
|
| Rate for Payer: Humana KY Medicaid |
$1,441.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,455.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.97
|
| Rate for Payer: PHCS Commercial |
$4,022.63
|
| Rate for Payer: United Healthcare All Payer |
$3,687.41
|
|
|
CBL ASSBLY W/CERCRMP 1.8*635MM
|
Facility
|
IP
|
$4,190.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.73 |
| Max. Negotiated Rate |
$4,022.63 |
| Rate for Payer: Humana Commercial |
$3,561.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.97
|
| Rate for Payer: PHCS Commercial |
$4,022.63
|
| Rate for Payer: United Healthcare All Payer |
$3,687.41
|
| Rate for Payer: Aetna Commercial |
$3,226.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.39
|
| Rate for Payer: Cash Price |
$2,095.12
|
| Rate for Payer: Cigna Commercial |
$3,477.90
|
| Rate for Payer: First Health Commercial |
$3,980.73
|
|
|
CBL ASSBLY W/CERCRMP 1.8*910MM
|
Facility
|
OP
|
$5,595.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.35 |
| Max. Negotiated Rate |
$5,371.20 |
| Rate for Payer: Aetna Commercial |
$4,308.15
|
| Rate for Payer: Anthem Medicaid |
$1,924.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,364.10
|
| Rate for Payer: Cash Price |
$2,797.50
|
| Rate for Payer: Cigna Commercial |
$4,643.85
|
| Rate for Payer: First Health Commercial |
$5,315.25
|
| Rate for Payer: Humana Commercial |
$4,755.75
|
| Rate for Payer: Humana KY Medicaid |
$1,924.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,943.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,587.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,129.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,678.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,962.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,923.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,196.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,734.45
|
| Rate for Payer: PHCS Commercial |
$5,371.20
|
| Rate for Payer: United Healthcare All Payer |
$4,923.60
|
|
|
CBL ASSBLY W/CERCRMP 1.8*910MM
|
Facility
|
IP
|
$5,595.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$727.35 |
| Max. Negotiated Rate |
$5,371.20 |
| Rate for Payer: Aetna Commercial |
$4,308.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,364.10
|
| Rate for Payer: Cash Price |
$2,797.50
|
| Rate for Payer: Cigna Commercial |
$4,643.85
|
| Rate for Payer: First Health Commercial |
$5,315.25
|
| Rate for Payer: Humana Commercial |
$4,755.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,587.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,129.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,678.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,923.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,196.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,119.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,734.45
|
| Rate for Payer: PHCS Commercial |
$5,371.20
|
| Rate for Payer: United Healthcare All Payer |
$4,923.60
|
|
|
CC BLADDER INSTILL CHEMO AGENT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102070
|
|
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
|
|
|
CC BLADDER INSTILL CHEMO AGENT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102070
|
|
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
|
|
|
CCIIV3 VAC NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90661
|
| Hospital Charge Code |
77000023
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
