|
I&D DEEP KNEE OR THIGH
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
45000156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,038.90 |
| Max. Negotiated Rate |
$3,324.48 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP KNEE OR THIGH
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
45000156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,190.93 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem Medicaid |
$1,190.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Humana KY Medicaid |
$1,190.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,203.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP KNEE OR THIGH(P
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
761P0808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.59 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$720.26
|
| Rate for Payer: Ambetter Exchange |
$485.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$261.28
|
| Rate for Payer: Anthem Medicaid |
$250.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$485.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$485.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$582.54
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$779.99
|
| Rate for Payer: Healthspan PPO |
$838.56
|
| Rate for Payer: Humana Medicaid |
$250.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$617.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$485.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$485.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Molina Healthcare Passport |
$250.59
|
| Rate for Payer: Multiplan PHCS |
$704.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$631.09
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$485.45
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,190.93 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem Medicaid |
$1,190.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Humana KY Medicaid |
$1,190.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,203.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,038.90 |
| Max. Negotiated Rate |
$3,324.48 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP SHOULDER AREA
|
Professional
|
Both
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$2,432.40 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Ambetter Exchange |
$242.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.33
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$242.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$291.07
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$416.05
|
| Rate for Payer: Healthspan PPO |
$532.22
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$242.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$2,432.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.33
|
| Rate for Payer: UHCCP Medicaid |
$137.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.56
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
IP
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,216.20 |
| Max. Negotiated Rate |
$3,891.84 |
| Rate for Payer: Aetna Commercial |
$3,121.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.12
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$3,364.82
|
| Rate for Payer: First Health Commercial |
$3,851.30
|
| Rate for Payer: Humana Commercial |
$3,445.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,991.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,567.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,526.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.26
|
| Rate for Payer: PHCS Commercial |
$3,891.84
|
| Rate for Payer: United Healthcare All Payer |
$3,567.52
|
|
|
I&D DEEP SHOULDER AREA
|
Facility
|
OP
|
$4,054.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
76100432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,394.17 |
| Max. Negotiated Rate |
$3,891.84 |
| Rate for Payer: Aetna Commercial |
$3,121.58
|
| Rate for Payer: Anthem Medicaid |
$1,394.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cash Price |
$2,027.00
|
| Rate for Payer: Cigna Commercial |
$3,364.82
|
| Rate for Payer: First Health Commercial |
$3,851.30
|
| Rate for Payer: Humana Commercial |
$3,445.90
|
| Rate for Payer: Humana KY Medicaid |
$1,394.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,408.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,324.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,991.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,422.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,567.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,040.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,526.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.26
|
| Rate for Payer: PHCS Commercial |
$3,891.84
|
| Rate for Payer: United Healthcare All Payer |
$3,567.52
|
|
|
I&D DEEP SHOULDER AREA(P
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761P0432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$532.22 |
| Rate for Payer: Aetna Commercial |
$376.18
|
| Rate for Payer: Ambetter Exchange |
$242.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.33
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$242.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$242.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$291.07
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$416.05
|
| Rate for Payer: Healthspan PPO |
$532.22
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$317.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$242.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$354.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.33
|
| Rate for Payer: UHCCP Medicaid |
$137.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$242.56
|
|
|
I&D DEEP SHOULDER AREA(T
|
Facility
|
OP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761T0432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,190.93 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem Medicaid |
$1,190.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Humana KY Medicaid |
$1,190.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,203.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D DEEP SHOULDER AREA(T
|
Facility
|
IP
|
$3,463.00
|
|
|
Service Code
|
HCPCS 23030
|
| Hospital Charge Code |
761T0432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,038.90 |
| Max. Negotiated Rate |
$3,324.48 |
| Rate for Payer: Aetna Commercial |
$2,666.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,701.14
|
| Rate for Payer: Cash Price |
$1,731.50
|
| Rate for Payer: Cigna Commercial |
$2,874.29
|
| Rate for Payer: First Health Commercial |
$3,289.85
|
| Rate for Payer: Humana Commercial |
$2,943.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,597.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,012.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,389.47
|
| Rate for Payer: PHCS Commercial |
$3,324.48
|
| Rate for Payer: United Healthcare All Payer |
$3,047.44
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
IP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
45000286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$793.50 |
| Max. Negotiated Rate |
$2,539.20 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$793.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,301.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,825.05
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
761P2140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$342.70
|
| Rate for Payer: Ambetter Exchange |
$202.87
|
| Rate for Payer: Anthem Medicaid |
$125.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.44
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$311.35
|
| Rate for Payer: Healthspan PPO |
$331.82
|
| Rate for Payer: Humana Medicaid |
$125.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.51
|
| Rate for Payer: Molina Healthcare Passport |
$125.99
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.73
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.87
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Facility
|
OP
|
$2,645.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
45000286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$909.62 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$2,036.65
|
| Rate for Payer: Anthem Medicaid |
$909.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,063.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cash Price |
$1,322.50
|
| Rate for Payer: Cigna Commercial |
$2,195.35
|
| Rate for Payer: First Health Commercial |
$2,512.75
|
| Rate for Payer: Humana Commercial |
$2,248.25
|
| Rate for Payer: Humana KY Medicaid |
$909.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$918.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,168.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,952.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$927.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,327.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,983.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,116.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,301.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,825.05
|
| Rate for Payer: PHCS Commercial |
$2,539.20
|
| Rate for Payer: United Healthcare All Payer |
$2,327.60
|
|
|
I&D EPIDIDYM TESTISSCROTALSPAC
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 54700
|
| Hospital Charge Code |
76102140
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.99 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$342.70
|
| Rate for Payer: Ambetter Exchange |
$202.87
|
| Rate for Payer: Anthem Medicaid |
$125.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.44
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$311.35
|
| Rate for Payer: Healthspan PPO |
$331.82
|
| Rate for Payer: Humana Medicaid |
$125.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.51
|
| Rate for Payer: Molina Healthcare Passport |
$125.99
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.73
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.87
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Professional
|
Both
|
$4,776.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.37 |
| Max. Negotiated Rate |
$2,865.60 |
| Rate for Payer: Aetna Commercial |
$557.07
|
| Rate for Payer: Ambetter Exchange |
$404.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.27
|
| Rate for Payer: Anthem Medicaid |
$197.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$404.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$404.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$485.82
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$517.32
|
| Rate for Payer: Healthspan PPO |
$575.40
|
| Rate for Payer: Humana Medicaid |
$197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$507.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$404.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.32
|
| Rate for Payer: Molina Healthcare Passport |
$197.37
|
| Rate for Payer: Multiplan PHCS |
$2,865.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$526.30
|
| Rate for Payer: UHCCP Medicaid |
$231.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$404.85
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
OP
|
$4,126.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
761T1910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$3,960.96 |
| Rate for Payer: Aetna Commercial |
$3,177.02
|
| Rate for Payer: Anthem Medicaid |
$1,418.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,218.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cigna Commercial |
$3,424.58
|
| Rate for Payer: First Health Commercial |
$3,919.70
|
| Rate for Payer: Humana Commercial |
$3,507.10
|
| Rate for Payer: Humana KY Medicaid |
$1,418.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,383.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,094.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,589.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.94
|
| Rate for Payer: PHCS Commercial |
$3,960.96
|
| Rate for Payer: United Healthcare All Payer |
$3,630.88
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
IP
|
$4,126.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
761T1910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,237.80 |
| Max. Negotiated Rate |
$3,960.96 |
| Rate for Payer: Aetna Commercial |
$3,177.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,218.28
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cigna Commercial |
$3,424.58
|
| Rate for Payer: First Health Commercial |
$3,919.70
|
| Rate for Payer: Humana Commercial |
$3,507.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,383.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,094.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,589.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.94
|
| Rate for Payer: PHCS Commercial |
$3,960.96
|
| Rate for Payer: United Healthcare All Payer |
$3,630.88
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
761P1910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.37 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$557.07
|
| Rate for Payer: Ambetter Exchange |
$404.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.27
|
| Rate for Payer: Anthem Medicaid |
$197.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$404.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$404.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$485.82
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$517.32
|
| Rate for Payer: Healthspan PPO |
$575.40
|
| Rate for Payer: Humana Medicaid |
$197.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$507.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$404.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.32
|
| Rate for Payer: Molina Healthcare Passport |
$197.37
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$526.30
|
| Rate for Payer: UHCCP Medicaid |
$231.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$404.85
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,432.80 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,155.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,295.44
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
OP
|
$4,126.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
45000268
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$3,960.96 |
| Rate for Payer: Aetna Commercial |
$3,177.02
|
| Rate for Payer: Anthem Medicaid |
$1,418.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,218.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cigna Commercial |
$3,424.58
|
| Rate for Payer: First Health Commercial |
$3,919.70
|
| Rate for Payer: Humana Commercial |
$3,507.10
|
| Rate for Payer: Humana KY Medicaid |
$1,418.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,383.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,094.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,589.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.94
|
| Rate for Payer: PHCS Commercial |
$3,960.96
|
| Rate for Payer: United Healthcare All Payer |
$3,630.88
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
76101910
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,155.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,295.44
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
I&D ISCHIORECTL PERIRECTL ABSC
|
Facility
|
IP
|
$4,126.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
45000268
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,237.80 |
| Max. Negotiated Rate |
$3,960.96 |
| Rate for Payer: Aetna Commercial |
$3,177.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,218.28
|
| Rate for Payer: Cash Price |
$2,063.00
|
| Rate for Payer: Cigna Commercial |
$3,424.58
|
| Rate for Payer: First Health Commercial |
$3,919.70
|
| Rate for Payer: Humana Commercial |
$3,507.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,383.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,094.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,300.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,589.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,846.94
|
| Rate for Payer: PHCS Commercial |
$3,960.96
|
| Rate for Payer: United Healthcare All Payer |
$3,630.88
|
|
