|
CRT CROME HF MRI SURESCAN
|
Facility
|
IP
|
$93,925.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,177.56 |
| Max. Negotiated Rate |
$90,168.19 |
| Rate for Payer: Aetna Commercial |
$72,322.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,261.66
|
| Rate for Payer: Cash Price |
$46,962.60
|
| Rate for Payer: Cigna Commercial |
$77,957.92
|
| Rate for Payer: First Health Commercial |
$89,228.94
|
| Rate for Payer: Humana Commercial |
$79,836.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,018.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,177.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,654.18
|
| Rate for Payer: Ohio Health Group HMO |
$70,443.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,140.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,714.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,808.39
|
| Rate for Payer: PHCS Commercial |
$90,168.19
|
| Rate for Payer: United Healthcare All Payer |
$82,654.18
|
|
|
CRT CROME HF MRI SURESCAN
|
Facility
|
OP
|
$93,925.20
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$28,177.56 |
| Max. Negotiated Rate |
$90,168.19 |
| Rate for Payer: Aetna Commercial |
$72,322.40
|
| Rate for Payer: Anthem Medicaid |
$32,300.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,261.66
|
| Rate for Payer: Cash Price |
$46,962.60
|
| Rate for Payer: Cigna Commercial |
$77,957.92
|
| Rate for Payer: First Health Commercial |
$89,228.94
|
| Rate for Payer: Humana Commercial |
$79,836.42
|
| Rate for Payer: Humana KY Medicaid |
$32,300.88
|
| Rate for Payer: Kentucky WC Medicaid |
$32,629.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,018.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,316.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,177.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,948.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,654.18
|
| Rate for Payer: Ohio Health Group HMO |
$70,443.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,140.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,714.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,808.39
|
| Rate for Payer: PHCS Commercial |
$90,168.19
|
| Rate for Payer: United Healthcare All Payer |
$82,654.18
|
|
|
CR TIBIAL BEARING 14MM
|
Facility
|
IP
|
$5,442.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,632.75 |
| Max. Negotiated Rate |
$5,224.80 |
| Rate for Payer: Aetna Commercial |
$4,190.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,245.15
|
| Rate for Payer: Cash Price |
$2,721.25
|
| Rate for Payer: Cigna Commercial |
$4,517.27
|
| Rate for Payer: First Health Commercial |
$5,170.38
|
| Rate for Payer: Humana Commercial |
$4,626.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,462.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,789.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,081.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,734.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,755.32
|
| Rate for Payer: PHCS Commercial |
$5,224.80
|
| Rate for Payer: United Healthcare All Payer |
$4,789.40
|
|
|
CR TIBIAL BEARING 14MM
|
Facility
|
OP
|
$5,442.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,632.75 |
| Max. Negotiated Rate |
$5,224.80 |
| Rate for Payer: Aetna Commercial |
$4,190.73
|
| Rate for Payer: Anthem Medicaid |
$1,871.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,245.15
|
| Rate for Payer: Cash Price |
$2,721.25
|
| Rate for Payer: Cigna Commercial |
$4,517.27
|
| Rate for Payer: First Health Commercial |
$5,170.38
|
| Rate for Payer: Humana Commercial |
$4,626.12
|
| Rate for Payer: Humana KY Medicaid |
$1,871.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,462.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,909.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,789.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,081.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,734.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,755.32
|
| Rate for Payer: PHCS Commercial |
$5,224.80
|
| Rate for Payer: United Healthcare All Payer |
$4,789.40
|
|
|
CRT ULTRA TIB INS SZ 2 10MM
|
Facility
|
IP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 10MM
|
Facility
|
OP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem Medicaid |
$3,112.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Humana KY Medicaid |
$3,112.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,143.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 12MM
|
Facility
|
IP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 12MM
|
Facility
|
OP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem Medicaid |
$3,112.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Humana KY Medicaid |
$3,112.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,143.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 14MM
|
Facility
|
OP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem Medicaid |
$3,112.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Humana KY Medicaid |
$3,112.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,143.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 14MM
|
Facility
|
IP
|
$9,049.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,714.75 |
| Max. Negotiated Rate |
$8,687.21 |
| Rate for Payer: Aetna Commercial |
$6,967.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,058.36
|
| Rate for Payer: Cash Price |
$4,524.59
|
| Rate for Payer: Cigna Commercial |
$7,510.82
|
| Rate for Payer: First Health Commercial |
$8,596.72
|
| Rate for Payer: Humana Commercial |
$7,691.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,420.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,678.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,714.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,786.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,239.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,872.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,243.93
|
| Rate for Payer: PHCS Commercial |
$8,687.21
|
| Rate for Payer: United Healthcare All Payer |
$7,963.28
|
|
|
CRT ULTRA TIB INS SZ 2 16MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CRT ULTRA TIB INS SZ 2 16MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CRYO OF CERVIX
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.22
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
CRYO OF CERVIX
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.80 |
| Max. Negotiated Rate |
$708.48 |
| Rate for Payer: Aetna Commercial |
$568.26
|
| Rate for Payer: Anthem Medicaid |
$253.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$612.54
|
| Rate for Payer: First Health Commercial |
$701.10
|
| Rate for Payer: Humana Commercial |
$627.30
|
| Rate for Payer: Humana KY Medicaid |
$253.80
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$605.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$544.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$258.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$649.44
|
| Rate for Payer: Ohio Health Group HMO |
$553.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$642.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.22
|
| Rate for Payer: PHCS Commercial |
$708.48
|
| Rate for Payer: United Healthcare All Payer |
$649.44
|
|
|
CRYO OF CERVIX
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
76102201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$442.80 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Ambetter Exchange |
$138.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.09
|
| Rate for Payer: Anthem Medicaid |
$81.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.66
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna Commercial |
$217.78
|
| Rate for Payer: Healthspan PPO |
$209.72
|
| Rate for Payer: Humana Medicaid |
$81.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$138.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.84
|
| Rate for Payer: Molina Healthcare Passport |
$81.22
|
| Rate for Payer: Multiplan PHCS |
$442.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.47
|
| Rate for Payer: UHCCP Medicaid |
$112.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.05
|
|
|
CRYO OF CERVIX(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761P2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$217.78 |
| Rate for Payer: Aetna Commercial |
$197.33
|
| Rate for Payer: Ambetter Exchange |
$138.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$107.09
|
| Rate for Payer: Anthem Medicaid |
$81.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$138.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$138.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.66
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$217.78
|
| Rate for Payer: Healthspan PPO |
$209.72
|
| Rate for Payer: Humana Medicaid |
$81.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$138.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.84
|
| Rate for Payer: Molina Healthcare Passport |
$81.22
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.47
|
| Rate for Payer: UHCCP Medicaid |
$112.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$138.05
|
|
|
CRYO OF CERVIX(T
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761T2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$393.50 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
CRYO OF CERVIX(T
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 57511
|
| Hospital Charge Code |
761T2201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
CRYOPRECIPITATED AHF PRECIP 4
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
38000007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$240.60 |
| Max. Negotiated Rate |
$769.92 |
| Rate for Payer: Aetna Commercial |
$617.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.56
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cigna Commercial |
$665.66
|
| Rate for Payer: First Health Commercial |
$761.90
|
| Rate for Payer: Humana Commercial |
$681.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.76
|
| Rate for Payer: Ohio Health Group HMO |
$601.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.38
|
| Rate for Payer: PHCS Commercial |
$769.92
|
| Rate for Payer: United Healthcare All Payer |
$705.76
|
|
|
CRYOPRECIPITATED AHF PRECIP 4
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
38000007
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$769.92 |
| Rate for Payer: Aetna Commercial |
$617.54
|
| Rate for Payer: Anthem Medicaid |
$275.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$58.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$82.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.30
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cash Price |
$401.00
|
| Rate for Payer: Cigna Commercial |
$665.66
|
| Rate for Payer: First Health Commercial |
$761.90
|
| Rate for Payer: Humana Commercial |
$681.70
|
| Rate for Payer: Humana KY Medicaid |
$275.81
|
| Rate for Payer: Humana Medicare Advantage |
$58.74
|
| Rate for Payer: Kentucky WC Medicaid |
$278.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.76
|
| Rate for Payer: Ohio Health Group HMO |
$601.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$641.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$553.38
|
| Rate for Payer: PHCS Commercial |
$769.92
|
| Rate for Payer: United Healthcare All Payer |
$705.76
|
|
|
CRYOPROBE LONG SHAFT RA 1.7
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
CRYOPROBE LONG SHAFT RA 1.7
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
CRYOPROBE RENAL OBLONG ICE 1.7
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
CRYOPROBE RENAL OBLONG ICE 1.7
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
CRYOPROBE RIGHT ANGLE 2.4MM
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
