|
CRYOSURGERY PENIS LESION(S)
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
76102125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.18
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.61
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
CRYOSURGERY PENIS LESION(S)(P
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761P2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.55
|
| Rate for Payer: Anthem Medicaid |
$43.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$172.70
|
| Rate for Payer: Healthspan PPO |
$187.02
|
| Rate for Payer: Humana Medicaid |
$43.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.86
|
| Rate for Payer: Molina Healthcare Passport |
$43.00
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.00
|
| Rate for Payer: UHCCP Medicaid |
$58.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.43
|
|
|
CRYOSURGERY PENIS LESION(S)(T
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761T2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
CRYOSURGERY PENIS LESION(S)(T
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
761T2125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$89.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$89.76
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$90.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$539.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$299.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$529.16
|
| Rate for Payer: Healthspan PPO |
$527.86
|
| Rate for Payer: Humana Medicaid |
$299.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.10
|
| Rate for Payer: Molina Healthcare Passport |
$299.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.11
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CRYOTHERAPY - DESTRUCTION
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
76102386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CRYOTHERAPY - DESTRUCTION(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 66720
|
| Hospital Charge Code |
761P2386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$539.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$299.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$529.16
|
| Rate for Payer: Healthspan PPO |
$527.86
|
| Rate for Payer: Humana Medicaid |
$299.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$509.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.10
|
| Rate for Payer: Molina Healthcare Passport |
$299.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.11
|
|
|
CRYOTHERAPY OF SKIN
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem Medicaid |
$69.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Humana KY Medicaid |
$69.47
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$70.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
CRYOTHERAPY OF SKIN
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$25.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$62.81
|
| Rate for Payer: Healthspan PPO |
$55.48
|
| Rate for Payer: Humana Medicaid |
$25.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.17
|
| Rate for Payer: Molina Healthcare Passport |
$25.66
|
| Rate for Payer: Multiplan PHCS |
$121.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$141.40
|
| Rate for Payer: UHCCP Medicaid |
$34.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.92
|
|
|
CRYOTHERAPY OF SKIN
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.62
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
CRYOTHERAPY OF SKIN(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761P0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$67.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.52
|
| Rate for Payer: Anthem Medicaid |
$25.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$62.81
|
| Rate for Payer: Healthspan PPO |
$55.48
|
| Rate for Payer: Humana Medicaid |
$25.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.17
|
| Rate for Payer: Molina Healthcare Passport |
$25.66
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$34.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.92
|
|
|
CRYOTHERAPY OF SKIN(T
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761T0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
CRYOTHERAPY OF SKIN(T
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 17340
|
| Hospital Charge Code |
761T0272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$35.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$35.08
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
CRYPTOCCUS NEOFORM SER ANTIG
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 87327
|
| Hospital Charge Code |
30001347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CRYPTOCCUS NEOFORM SER ANTIG
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 87327
|
| Hospital Charge Code |
30001347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$13.42
|
| Rate for Payer: Humana Medicare Advantage |
$13.42
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
CRYPTOSPORIDIUM DFA DETECTION
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
30001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.98
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$11.98
|
| Rate for Payer: Humana Medicare Advantage |
$11.98
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
CRYPTOSPORIDIUM DFA DETECTION
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87272
|
| Hospital Charge Code |
30001343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$7.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$7.33
|
| Rate for Payer: Humana Medicare Advantage |
$7.33
|
| Rate for Payer: Kentucky WC Medicaid |
$7.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.40
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
CRYSTAL ID SCOPE W/WO PLRZ LNS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 89060
|
| Hospital Charge Code |
30001548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$29.67
|
| Rate for Payer: Healthspan PPO |
$7.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.44
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.40
|
|
|
C-SECTION
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,537.35
|
| Rate for Payer: Anthem Medicaid |
$870.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,417.36
|
| Rate for Payer: Healthspan PPO |
$1,050.00
|
| Rate for Payer: Humana Medicaid |
$870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,417.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$887.40
|
| Rate for Payer: Molina Healthcare Passport |
$870.00
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$878.70
|
|
|
C-SECTION
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
C-SECTION
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 59514
|
| Hospital Charge Code |
72000023
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
C-SECTION EMERGENCY ROOM
|
Facility
|
OP
|
$3,193.00
|
|
| Hospital Charge Code |
76102549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.09 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem Medicaid |
$1,098.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Humana KY Medicaid |
$1,098.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,120.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$989.83
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
