|
HYSTEROSCOPY REMOVAL OF IUD
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58579
|
| Hospital Charge Code |
76102243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| 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 |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| 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 |
$185.88
|
| 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 |
$223.06
|
| 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 |
$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
|
|
|
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 |
$700.00 |
| 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(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 |
$700.00 |
| 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 |
$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
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Ambetter Exchange |
$209.49
|
| 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 Individual/Medicaid |
$209.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.39
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$209.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.49
|
| 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 |
$272.34
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.49
|
|
|
HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 58562
|
| Hospital Charge Code |
76102237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$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
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$451.01
|
| Rate for Payer: Ambetter Exchange |
$209.49
|
| 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 Individual/Medicaid |
$209.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.39
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$209.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.49
|
| 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 |
$272.34
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.49
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 58559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 58562
|
|
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, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 58558
|
|
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 W/D & C
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
76102234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
$474.73 |
| Rate for Payer: Aetna Commercial |
$413.24
|
| Rate for Payer: Ambetter Exchange |
$219.31
|
| 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 Individual/Medicaid |
$219.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$219.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.31
|
| 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 |
$285.10
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.31
|
|
|
HYSTEROSCOPY W/D & C
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 58558
|
| Hospital Charge Code |
76102234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| 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 |
$474.73 |
| Rate for Payer: Aetna Commercial |
$413.24
|
| Rate for Payer: Ambetter Exchange |
$219.31
|
| 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 Individual/Medicaid |
$219.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$219.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$263.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$219.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.31
|
| 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 |
$285.10
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$219.31
|
|
|
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: Ambetter Exchange |
$232.67
|
| 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 Individual/Medicaid |
$232.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$232.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$232.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.67
|
| 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 |
$302.47
|
| Rate for Payer: UHCCP Medicaid |
$242.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$232.67
|
|
|
HYSTEROSCOPY W/ END. ABLATION
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
76102238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.50 |
| 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 |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
HYSTEROSCOPY W/ END. ABLATION
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 58563
|
| Hospital Charge Code |
76102238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.15 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| 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 |
$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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| 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: Ambetter Exchange |
$232.67
|
| 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 Individual/Medicaid |
$232.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$232.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$232.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.67
|
| 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 |
$302.47
|
| Rate for Payer: UHCCP Medicaid |
$242.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$232.67
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
76102236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| 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 |
$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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
HYSTEROSCOPY W/REMVL LEIOMYMTA
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
76102236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.00 |
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| 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: Ambetter Exchange |
$338.68
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$338.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$338.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.68
|
| 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 |
$440.28
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.68
|
|
|
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: Ambetter Exchange |
$338.68
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$338.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$338.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.68
|
| 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 |
$440.28
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.68
|
|
|
HYSTROSCOPE SHEATH 15FR OVAL
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
