|
HYPOCURE SINUS TARSI IMP SZ 8
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 9
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 9
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
HYSEPT 50 (DAKIN0.5%EQUIV) SOL
|
Facility
|
IP
|
$1.39
|
|
|
Service Code
|
NDC 39328006250
|
| Hospital Charge Code |
25003111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
HYSEPT 50 (DAKIN0.5%EQUIV) SOL
|
Facility
|
OP
|
$1.39
|
|
|
Service Code
|
NDC 39328006250
|
| Hospital Charge Code |
25003111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: Anthem Medicaid |
$0.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.08
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna Commercial |
$1.15
|
| Rate for Payer: First Health Commercial |
$1.32
|
| Rate for Payer: Humana Commercial |
$1.18
|
| Rate for Payer: Humana KY Medicaid |
$0.48
|
| Rate for Payer: Kentucky WC Medicaid |
$0.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.22
|
| Rate for Payer: Ohio Health Group HMO |
$1.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.96
|
| Rate for Payer: PHCS Commercial |
$1.33
|
| Rate for Payer: United Healthcare All Payer |
$1.22
|
|
|
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 |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,301.64
|
| Rate for Payer: Ambetter Exchange |
$692.17
|
| Rate for Payer: Anthem Medicaid |
$617.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$692.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.17
|
| 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 |
$899.82
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.17
|
|
|
HYSTERECTOMY - LAP SUPRACERVI
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
76102227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.70 |
| Max. Negotiated Rate |
$13,467.66 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,619.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,467.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,986.68
|
| 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 |
$9,619.76
|
| 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 |
$11,543.71
|
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
HYSTERECTOMY - LAP SUPRACERVI
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58541
|
| Hospital Charge Code |
76102227
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| 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 |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| 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 |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,301.64
|
| Rate for Payer: Ambetter Exchange |
$692.17
|
| Rate for Payer: Anthem Medicaid |
$617.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$692.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.17
|
| 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 |
$899.82
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.17
|
|
|
HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$647.04 |
| Rate for Payer: Aetna Commercial |
$518.98
|
| Rate for Payer: Anthem Medicaid |
$231.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$525.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$559.42
|
| Rate for Payer: First Health Commercial |
$640.30
|
| Rate for Payer: Humana Commercial |
$572.90
|
| Rate for Payer: Humana KY Medicaid |
$231.79
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$234.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$552.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$497.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$593.12
|
| Rate for Payer: Ohio Health Group HMO |
$505.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$539.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.06
|
| Rate for Payer: PHCS Commercial |
$647.04
|
| Rate for Payer: United Healthcare All Payer |
$593.12
|
|
|
HYSTEROSALPINGOGRAM
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$404.40 |
| Rate for Payer: Aetna Commercial |
$117.72
|
| Rate for Payer: Ambetter Exchange |
$81.07
|
| Rate for Payer: Anthem Medicaid |
$51.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.28
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cash Price |
$337.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$81.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.67
|
| Rate for Payer: Molina Healthcare Passport |
$51.64
|
| Rate for Payer: Multiplan PHCS |
$404.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.39
|
| Rate for Payer: UHCCP Medicaid |
$235.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.07
|
|
|
HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
32000148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$647.04 |
| Rate for Payer: Aetna Commercial |
$518.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$525.72
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cigna Commercial |
$559.42
|
| Rate for Payer: First Health Commercial |
$640.30
|
| Rate for Payer: Humana Commercial |
$572.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$552.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$497.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$593.12
|
| Rate for Payer: Ohio Health Group HMO |
$505.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$539.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$586.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.06
|
| Rate for Payer: PHCS Commercial |
$647.04
|
| Rate for Payer: United Healthcare All Payer |
$593.12
|
|
|
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: Ambetter Exchange |
$81.07
|
| Rate for Payer: Anthem Medicaid |
$51.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$81.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.07
|
| 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 |
$105.39
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.07
|
|
|
HYSTEROSALPINGOGRAM(T
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
320T0148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.70 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
HYSTEROSALPINGOGRAM(T
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
HCPCS 74740
|
| Hospital Charge Code |
320T0148
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Anthem Medicaid |
$206.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$467.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cash Price |
$299.50
|
| Rate for Payer: Cigna Commercial |
$497.17
|
| Rate for Payer: First Health Commercial |
$569.05
|
| Rate for Payer: Humana Commercial |
$509.15
|
| Rate for Payer: Humana KY Medicaid |
$206.00
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$208.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$491.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$527.12
|
| Rate for Payer: Ohio Health Group HMO |
$449.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$413.31
|
| Rate for Payer: PHCS Commercial |
$575.04
|
| Rate for Payer: United Healthcare All Payer |
$527.12
|
|
|
HYSTEROSCOPY
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
76102233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$223.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
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 |
$390.00 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Ambetter Exchange |
$144.15
|
| 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 Individual/Medicaid |
$144.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$144.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.15
|
| 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 |
$187.40
|
| Rate for Payer: UHCCP Medicaid |
$85.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.15
|
|
|
HYSTEROSCOPY
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 58555
|
| Hospital Charge Code |
76102233
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| 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 |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 58555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| 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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
HYSTEROSCOPY LYSIS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| 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 |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
HYSTEROSCOPY LYSIS
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
76102235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Ambetter Exchange |
$268.58
|
| Rate for Payer: Anthem Medicaid |
$273.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$268.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$268.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$268.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.58
|
| 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 |
$349.15
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$268.58
|
|
|
HYSTEROSCOPY LYSIS(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 58559
|
| Hospital Charge Code |
761P2235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.58 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$531.92
|
| Rate for Payer: Ambetter Exchange |
$268.58
|
| Rate for Payer: Anthem Medicaid |
$273.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$268.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$268.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.30
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$268.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.58
|
| 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 |
$349.15
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$268.58
|
|
|
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 |
$390.00 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Ambetter Exchange |
$144.15
|
| 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 Individual/Medicaid |
$144.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$144.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.15
|
| 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 |
$187.40
|
| Rate for Payer: UHCCP Medicaid |
$85.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.15
|
|
|
HYSTEROSCOPY REMOVAL OF IUD
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
76102243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
