|
HYSEPT 50 (DAKIN0.5%EQUIV) SOL
|
Facility
|
IP
|
$1.31
|
|
|
Service Code
|
NDC 39328006250
|
| Hospital Charge Code |
25003111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.02
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna Commercial |
$1.09
|
| Rate for Payer: First Health Commercial |
$1.24
|
| Rate for Payer: Humana Commercial |
$1.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.15
|
| Rate for Payer: Ohio Health Group HMO |
$0.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Payer |
$1.15
|
|
|
HYSTERECTOMY - LAP SUPRACERVI
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
76102227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$12,462.13 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,901.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,462.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,017.05
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$8,901.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,681.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
HYSTERECTOMY - LAP SUPRACERVI
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
76102227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.90 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,301.64
|
| Rate for Payer: Anthem Medicaid |
$617.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,238.70
|
| Rate for Payer: Healthspan PPO |
$1,260.32
|
| Rate for Payer: Humana Medicaid |
$617.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,118.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.26
|
| Rate for Payer: Molina Healthcare Passport |
$617.90
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.08
|
|
|
HYSTERECTOMY - LAP SUPRACERVI
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
76102227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
HYSTERECTOMY - LAP SUPRACERV(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
761P2227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.90 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,301.64
|
| Rate for Payer: Anthem Medicaid |
$617.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,238.70
|
| Rate for Payer: Healthspan PPO |
$1,260.32
|
| Rate for Payer: Humana Medicaid |
$617.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,118.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.26
|
| Rate for Payer: Molina Healthcare Passport |
$617.90
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.08
|
|
|
HYSTEROSALPINGOGRAM
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$117.72
|
| Rate for Payer: Anthem Medicaid |
$51.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$637.00
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$107.89
|
| Rate for Payer: Healthspan PPO |
$110.31
|
| Rate for Payer: Humana Medicaid |
$51.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.67
|
| Rate for Payer: Molina Healthcare Passport |
$51.64
|
| Rate for Payer: Multiplan PHCS |
$382.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$445.90
|
| Rate for Payer: UHCCP Medicaid |
$222.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.16
|
|
|
HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.47
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.81 |
| Max. Negotiated Rate |
$611.52 |
| Rate for Payer: Aetna Commercial |
$490.49
|
| Rate for Payer: Anthem Medicaid |
$219.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$496.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cash Price |
$318.50
|
| Rate for Payer: Cigna Commercial |
$528.71
|
| Rate for Payer: First Health Commercial |
$605.15
|
| Rate for Payer: Humana Commercial |
$541.45
|
| Rate for Payer: Humana KY Medicaid |
$219.06
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$522.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$223.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$560.56
|
| Rate for Payer: Ohio Health Group HMO |
$477.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$197.47
|
| Rate for Payer: PHCS Commercial |
$611.52
|
| Rate for Payer: United Healthcare All Payer |
$560.56
|
|
|
HYSTEROSALPINGOGRAM(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
320P0148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Aetna Commercial |
$117.72
|
| Rate for Payer: Anthem Medicaid |
$51.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$107.89
|
| Rate for Payer: Healthspan PPO |
$110.31
|
| Rate for Payer: Humana Medicaid |
$51.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.67
|
| Rate for Payer: Molina Healthcare Passport |
$51.64
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.16
|
|
|
HYSTEROSALPINGOGRAM(T
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
320T0148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem Medicaid |
$193.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Humana KY Medicaid |
$193.27
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$195.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.22
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
HYSTEROSALPINGOGRAM(T
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
320T0148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$174.22
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
HYSTEROSCOPY
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
76102233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.22
|
| Rate for Payer: Anthem Medicaid |
$162.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$336.26
|
| Rate for Payer: Healthspan PPO |
$350.01
|
| Rate for Payer: Humana Medicaid |
$162.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.99
|
| Rate for Payer: Molina Healthcare Passport |
$162.74
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$85.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.37
|
|
|
HYSTEROSCOPY
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
76102233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
HYSTEROSCOPY
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
76102233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 58555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
HYSTEROSCOPY LYSIS
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.34 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Anthem Medicaid |
$273.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$523.50
|
| Rate for Payer: Healthspan PPO |
$515.03
|
| Rate for Payer: Humana Medicaid |
$273.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.81
|
| Rate for Payer: Molina Healthcare Passport |
$273.34
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.07
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
HYSTEROSCOPY LYSIS(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
761P2235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.34 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Anthem Medicaid |
$273.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$523.50
|
| Rate for Payer: Healthspan PPO |
$515.03
|
| Rate for Payer: Humana Medicaid |
$273.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.81
|
| Rate for Payer: Molina Healthcare Passport |
$273.34
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.07
|
|
|
HYSTEROSCOPY(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
761P2233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.22
|
| Rate for Payer: Anthem Medicaid |
$162.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$336.26
|
| Rate for Payer: Healthspan PPO |
$350.01
|
| Rate for Payer: Humana Medicaid |
$162.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.99
|
| Rate for Payer: Molina Healthcare Passport |
$162.74
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$85.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.37
|
|
|
HYSTEROSCOPY REMOVAL OF IUD
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
76102243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
HYSTEROSCOPY REMOVAL OF IUD
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
76102243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
HYSTEROSCOPY REMOVAL OF IUD
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
76102243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
HYSTEROSCOPY REMOVAL OF IUD(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
761P2243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
76102237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
