|
HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
76102237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$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 |
$2,703.53
|
| 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 |
$3,244.24
|
| 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 REMOVE FB
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
76102237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.99
|
| Rate for Payer: Anthem Medicaid |
$213.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$445.20
|
| Rate for Payer: Healthspan PPO |
$503.55
|
| Rate for Payer: Humana Medicaid |
$213.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.99
|
| Rate for Payer: Molina Healthcare Passport |
$213.72
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.86
|
|
|
HYSTEROSCOPY REMOVE FB(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
761P2237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.99
|
| Rate for Payer: Anthem Medicaid |
$213.72
|
| 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: Cigna Commercial |
$445.20
|
| Rate for Payer: Healthspan PPO |
$503.55
|
| Rate for Payer: Humana Medicaid |
$213.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.99
|
| Rate for Payer: Molina Healthcare Passport |
$213.72
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.86
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 58559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 58562
|
|
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, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 58558
|
|
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 W/D & C
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
76102234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
HYSTEROSCOPY W/D & C
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
76102234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$413.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.66
|
| Rate for Payer: Anthem Medicaid |
$213.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$459.70
|
| Rate for Payer: Healthspan PPO |
$474.73
|
| Rate for Payer: Humana Medicaid |
$213.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$348.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.53
|
| Rate for Payer: Molina Healthcare Passport |
$213.26
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.39
|
|
|
HYSTEROSCOPY W/D & C
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
76102234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
HYSTEROSCOPY W/D & C(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
761P2234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.66 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$413.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$117.66
|
| Rate for Payer: Anthem Medicaid |
$213.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$459.70
|
| Rate for Payer: Healthspan PPO |
$474.73
|
| Rate for Payer: Humana Medicaid |
$213.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$348.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.53
|
| Rate for Payer: Molina Healthcare Passport |
$213.26
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.39
|
|
|
HYSTEROSCOPY W/ END. ABLATION
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
76102238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| 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 |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
HYSTEROSCOPY W/ END. ABLATION
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
76102238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$2,548.03 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$230.63
|
| Rate for Payer: Anthem Medicaid |
$281.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,194.63
|
| Rate for Payer: Healthspan PPO |
$2,548.03
|
| Rate for Payer: Humana Medicaid |
$281.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.27
|
| Rate for Payer: Molina Healthcare Passport |
$281.64
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$242.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.46
|
|
|
HYSTEROSCOPY W/ END. ABLATION
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
76102238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
HYSTEROSCOPY W/ END. ABLATIO(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
761P2238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$2,548.03 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$230.63
|
| Rate for Payer: Anthem Medicaid |
$281.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,194.63
|
| Rate for Payer: Healthspan PPO |
$2,548.03
|
| Rate for Payer: Humana Medicaid |
$281.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$448.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.27
|
| Rate for Payer: Molina Healthcare Passport |
$281.64
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$242.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.46
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
76102236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$852.32 |
| Rate for Payer: Aetna Commercial |
$852.32
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$841.31
|
| Rate for Payer: Healthspan PPO |
$825.27
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
76102236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| 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 |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
761P2236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$852.32 |
| Rate for Payer: Aetna Commercial |
$852.32
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$841.31
|
| Rate for Payer: Healthspan PPO |
$825.27
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$716.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
76102236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
HYSTROSCOPE SHEATH 15FR OVAL
|
Facility
|
IP
|
$4,484.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.02 |
| Max. Negotiated Rate |
$4,305.41 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,498.14
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cigna Commercial |
$3,722.38
|
| Rate for Payer: First Health Commercial |
$4,260.56
|
| Rate for Payer: Humana Commercial |
$3,812.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,677.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,946.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.29
|
| Rate for Payer: PHCS Commercial |
$4,305.41
|
| Rate for Payer: United Healthcare All Payer |
$3,946.62
|
|
|
HYSTROSCOPE SHEATH 15FR OVAL
|
Facility
|
OP
|
$4,484.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$583.02 |
| Max. Negotiated Rate |
$4,305.41 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Anthem Medicaid |
$1,542.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,498.14
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cigna Commercial |
$3,722.38
|
| Rate for Payer: First Health Commercial |
$4,260.56
|
| Rate for Payer: Humana Commercial |
$3,812.08
|
| Rate for Payer: Humana KY Medicaid |
$1,542.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,558.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,677.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,573.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,946.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.29
|
| Rate for Payer: PHCS Commercial |
$4,305.41
|
| Rate for Payer: United Healthcare All Payer |
$3,946.62
|
|
|
HYTRIN (TERAZOSIN) 1 1MG/1TAB
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 378226001
|
| Hospital Charge Code |
25000766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
HYTRIN (TERAZOSIN) 1 1MG/1TAB
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 378226001
|
| Hospital Charge Code |
25000766
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
HYTRIN (TERAZOSIN) 2 2MG/1TAB
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 50268076515
|
| Hospital Charge Code |
25000767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
