|
CAUTERY/ABLATION
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| 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 |
$1,368.67
|
| 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 |
$1,642.40
|
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CAUTERY/ABLATION
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 30802
|
| Hospital Charge Code |
76101137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| 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 |
$43.75 |
| Max. Negotiated Rate |
$297.80 |
| Rate for Payer: Aetna Commercial |
$181.82
|
| Rate for Payer: Ambetter Exchange |
$136.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.77
|
| Rate for Payer: Anthem Medicaid |
$43.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.17
|
| 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 |
$43.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.62
|
| Rate for Payer: Molina Healthcare Passport |
$43.75
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.85
|
| Rate for Payer: UHCCP Medicaid |
$83.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.81
|
|
|
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 |
$328.32 |
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Ambetter Exchange |
$185.12
|
| 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 Individual/Medicaid |
$185.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.14
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$185.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.12
|
| 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 |
$240.66
|
| Rate for Payer: UHCCP Medicaid |
$111.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.12
|
|
|
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 |
$2,335.80 |
| Rate for Payer: Aetna Commercial |
$176.91
|
| Rate for Payer: Ambetter Exchange |
$106.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.67
|
| Rate for Payer: Anthem Medicaid |
$70.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.21
|
| 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 |
$70.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare Passport |
$70.42
|
| Rate for Payer: Multiplan PHCS |
$2,335.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.89
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.84
|
|
|
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 |
$201.83 |
| Rate for Payer: Aetna Commercial |
$176.91
|
| Rate for Payer: Ambetter Exchange |
$106.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$61.67
|
| Rate for Payer: Anthem Medicaid |
$70.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.21
|
| 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 |
$70.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.83
|
| Rate for Payer: Molina Healthcare Passport |
$70.42
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.89
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.84
|
|
|
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 |
$1,073.40 |
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| 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
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
761T2200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.47 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| 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 |
$1,167.90 |
| 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 |
$3,114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.17
|
| 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
|
$3,893.00
|
|
|
Service Code
|
HCPCS 57510
|
| Hospital Charge Code |
76102200
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,338.80 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,997.61
|
| Rate for Payer: Anthem Medicaid |
$1,338.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,036.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$3,114.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.17
|
| 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
|
$4,112.95
|
|
|
Service Code
|
CPT 57510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
CBC W/DIFF
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
CBC W/DIFF
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$7.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.77
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| 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 |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
CBC W/DIFF
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
30000569
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$47.40 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Ambetter Exchange |
$7.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$7.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$7.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.32
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$11.11
|
| Rate for Payer: Healthspan PPO |
$8.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$7.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.77
|
| Rate for Payer: Multiplan PHCS |
$47.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.10
|
| Rate for Payer: UHCCP Medicaid |
$27.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$7.77
|
|
|
CBC WITHOUT DIFF
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Aetna Commercial |
$10.84
|
| Rate for Payer: Ambetter Exchange |
$6.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$6.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$6.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.76
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$9.22
|
| Rate for Payer: Healthspan PPO |
$6.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$6.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.47
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$6.47
|
|
|
CBC WITHOUT DIFF
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| 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 |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
CBC WITHOUT DIFF
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
30000570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.21
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
CBL ASSBLY W/CERCRMP 1.8*22IN
|
Facility
|
OP
|
$4,132.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.72 |
| Max. Negotiated Rate |
$3,967.10 |
| Rate for Payer: Aetna Commercial |
$3,181.95
|
| Rate for Payer: Anthem Medicaid |
$1,421.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.27
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cigna Commercial |
$3,429.89
|
| Rate for Payer: First Health Commercial |
$3,925.78
|
| Rate for Payer: Humana Commercial |
$3,512.54
|
| Rate for Payer: Humana KY Medicaid |
$1,421.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,388.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,049.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,636.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.36
|
| Rate for Payer: PHCS Commercial |
$3,967.10
|
| Rate for Payer: United Healthcare All Payer |
$3,636.51
|
|
|
CBL ASSBLY W/CERCRMP 1.8*22IN
|
Facility
|
IP
|
$4,132.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.72 |
| Max. Negotiated Rate |
$3,967.10 |
| Rate for Payer: Aetna Commercial |
$3,181.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.27
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cigna Commercial |
$3,429.89
|
| Rate for Payer: First Health Commercial |
$3,925.78
|
| Rate for Payer: Humana Commercial |
$3,512.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,388.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,049.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,636.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.36
|
| Rate for Payer: PHCS Commercial |
$3,967.10
|
| Rate for Payer: United Healthcare All Payer |
$3,636.51
|
|
|
CBL ASSBLY W/CERCRMP 1.8*635MM
|
Facility
|
IP
|
$4,132.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.72 |
| Max. Negotiated Rate |
$3,967.10 |
| Rate for Payer: Aetna Commercial |
$3,181.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.27
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cigna Commercial |
$3,429.89
|
| Rate for Payer: First Health Commercial |
$3,925.78
|
| Rate for Payer: Humana Commercial |
$3,512.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,388.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,049.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,636.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.36
|
| Rate for Payer: PHCS Commercial |
$3,967.10
|
| Rate for Payer: United Healthcare All Payer |
$3,636.51
|
|
|
CBL ASSBLY W/CERCRMP 1.8*635MM
|
Facility
|
OP
|
$4,132.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.72 |
| Max. Negotiated Rate |
$3,967.10 |
| Rate for Payer: Aetna Commercial |
$3,181.95
|
| Rate for Payer: Anthem Medicaid |
$1,421.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.27
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cigna Commercial |
$3,429.89
|
| Rate for Payer: First Health Commercial |
$3,925.78
|
| Rate for Payer: Humana Commercial |
$3,512.54
|
| Rate for Payer: Humana KY Medicaid |
$1,421.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,388.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,049.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,636.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,305.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.36
|
| Rate for Payer: PHCS Commercial |
$3,967.10
|
| Rate for Payer: United Healthcare All Payer |
$3,636.51
|
|
|
CBL ASSBLY W/CERCRMP 1.8*910MM
|
Facility
|
OP
|
$5,637.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$4,340.88
|
| Rate for Payer: Anthem Medicaid |
$1,938.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,397.25
|
| Rate for Payer: Cash Price |
$2,818.75
|
| Rate for Payer: Cigna Commercial |
$4,679.12
|
| Rate for Payer: First Health Commercial |
$5,355.62
|
| Rate for Payer: Humana Commercial |
$4,791.88
|
| Rate for Payer: Humana KY Medicaid |
$1,938.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,961.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.88
|
| Rate for Payer: PHCS Commercial |
$5,412.00
|
| Rate for Payer: United Healthcare All Payer |
$4,961.00
|
|
|
CBL ASSBLY W/CERCRMP 1.8*910MM
|
Facility
|
IP
|
$5,637.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,691.25 |
| Max. Negotiated Rate |
$5,412.00 |
| Rate for Payer: Aetna Commercial |
$4,340.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,397.25
|
| Rate for Payer: Cash Price |
$2,818.75
|
| Rate for Payer: Cigna Commercial |
$4,679.12
|
| Rate for Payer: First Health Commercial |
$5,355.62
|
| Rate for Payer: Humana Commercial |
$4,791.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,961.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.88
|
| Rate for Payer: PHCS Commercial |
$5,412.00
|
| Rate for Payer: United Healthcare All Payer |
$4,961.00
|
|
|
CC BLADDER INSTILL CHEMO AGENT
|
Facility
|
IP
|
$1,356.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$1,301.76 |
| Rate for Payer: Aetna Commercial |
$1,044.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,057.68
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$1,125.48
|
| Rate for Payer: First Health Commercial |
$1,288.20
|
| Rate for Payer: Humana Commercial |
$1,152.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,000.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,193.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,017.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$935.64
|
| Rate for Payer: PHCS Commercial |
$1,301.76
|
| Rate for Payer: United Healthcare All Payer |
$1,193.28
|
|
|
CC BLADDER INSTILL CHEMO AGENT
|
Facility
|
OP
|
$1,356.00
|
|
|
Service Code
|
HCPCS 51720
|
| Hospital Charge Code |
76102070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$466.33 |
| Max. Negotiated Rate |
$1,301.76 |
| Rate for Payer: Aetna Commercial |
$1,044.12
|
| Rate for Payer: Anthem Medicaid |
$466.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,057.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$1,125.48
|
| Rate for Payer: First Health Commercial |
$1,288.20
|
| Rate for Payer: Humana Commercial |
$1,152.60
|
| Rate for Payer: Humana KY Medicaid |
$466.33
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Kentucky WC Medicaid |
$471.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,000.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$475.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,193.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,017.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$935.64
|
| Rate for Payer: PHCS Commercial |
$1,301.76
|
| Rate for Payer: United Healthcare All Payer |
$1,193.28
|
|
