|
ANTEPARTUM CARE 4-6 VISITS
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
72000019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ANTEPARTUM CARE 4-6 VISITS
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
72000019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
ANTEPARTUM CARE 4-6 VISITS(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
720P0019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$643.14 |
| Rate for Payer: Aetna Commercial |
$564.50
|
| Rate for Payer: Ambetter Exchange |
$414.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$222.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$414.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.39
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$643.14
|
| Rate for Payer: Healthspan PPO |
$510.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$427.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$414.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.49
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$538.84
|
| Rate for Payer: UHCCP Medicaid |
$233.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.49
|
|
|
ANTEPARTUM CARE 4-6 VISITS(T
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
720T0019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
ANTEPARTUM CARE 4-6 VISITS(T
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 59425
|
| Hospital Charge Code |
720T0019
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
ANTEPARTUM CARE 7 MORE VISIT
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
720P0020
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$406.63 |
| Max. Negotiated Rate |
$1,146.72 |
| Rate for Payer: Aetna Commercial |
$997.55
|
| Rate for Payer: Ambetter Exchange |
$761.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$406.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$761.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$761.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$913.69
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,146.72
|
| Rate for Payer: Healthspan PPO |
$911.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$761.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.41
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$989.83
|
| Rate for Payer: UHCCP Medicaid |
$426.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$761.41
|
|
|
ANTEPARTUM CARE 7 MORE VISIT
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
72000020
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
ANTEPARTUM CARE 7 MORE VISIT
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
72000020
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$406.63 |
| Max. Negotiated Rate |
$1,146.72 |
| Rate for Payer: Aetna Commercial |
$997.55
|
| Rate for Payer: Ambetter Exchange |
$761.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$406.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$761.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$761.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$913.69
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,146.72
|
| Rate for Payer: Healthspan PPO |
$911.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$761.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.41
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$989.83
|
| Rate for Payer: UHCCP Medicaid |
$426.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$761.41
|
|
|
ANTEPARTUM CARE 7 MORE VISIT
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 59426
|
| Hospital Charge Code |
72000020
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
ANTERIOR COLPORRHAPHY
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
76102180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
76102180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.11 |
| Max. Negotiated Rate |
$984.44 |
| Rate for Payer: Aetna Commercial |
$984.44
|
| Rate for Payer: Ambetter Exchange |
$580.33
|
| Rate for Payer: Anthem Medicaid |
$382.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$580.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$696.40
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$896.98
|
| Rate for Payer: Healthspan PPO |
$953.19
|
| Rate for Payer: Humana Medicaid |
$382.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$863.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$580.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.75
|
| Rate for Payer: Molina Healthcare Passport |
$382.11
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$754.43
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$580.33
|
|
|
ANTERIOR COLPORRHAPHY
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
76102180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
ANTERIOR COLPORRHAPHY(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 57240
|
| Hospital Charge Code |
761P2180
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.11 |
| Max. Negotiated Rate |
$984.44 |
| Rate for Payer: Aetna Commercial |
$984.44
|
| Rate for Payer: Ambetter Exchange |
$580.33
|
| Rate for Payer: Anthem Medicaid |
$382.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$580.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$696.40
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$896.98
|
| Rate for Payer: Healthspan PPO |
$953.19
|
| Rate for Payer: Humana Medicaid |
$382.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$863.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$580.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.75
|
| Rate for Payer: Molina Healthcare Passport |
$382.11
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$754.43
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$580.33
|
|
|
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 57240
|
|
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
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
76100838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.00 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.70
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
76100838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.50 |
| Max. Negotiated Rate |
$1,344.65 |
| Rate for Payer: Aetna Commercial |
$1,230.69
|
| Rate for Payer: Ambetter Exchange |
$777.90
|
| Rate for Payer: Anthem Medicaid |
$661.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$933.48
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$1,344.65
|
| Rate for Payer: Healthspan PPO |
$1,114.75
|
| Rate for Payer: Humana Medicaid |
$661.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.36
|
| Rate for Payer: Molina Healthcare Passport |
$661.14
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,011.27
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.90
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
76100838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.70
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 27418
|
| Hospital Charge Code |
761P0838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.50 |
| Max. Negotiated Rate |
$1,344.65 |
| Rate for Payer: Aetna Commercial |
$1,230.69
|
| Rate for Payer: Ambetter Exchange |
$777.90
|
| Rate for Payer: Anthem Medicaid |
$661.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$933.48
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$1,344.65
|
| Rate for Payer: Healthspan PPO |
$1,114.75
|
| Rate for Payer: Humana Medicaid |
$661.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.36
|
| Rate for Payer: Molina Healthcare Passport |
$661.14
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,011.27
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$667.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.90
|
|
|
ANTERIOR VESICOUR/URETHROPOX(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51841
|
| Hospital Charge Code |
761P2074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.33 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,238.97
|
| Rate for Payer: Ambetter Exchange |
$757.54
|
| Rate for Payer: Anthem Medicaid |
$686.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.05
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,150.76
|
| Rate for Payer: Healthspan PPO |
$990.67
|
| Rate for Payer: Humana Medicaid |
$686.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.06
|
| Rate for Payer: Molina Healthcare Passport |
$686.33
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.80
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.54
|
|
|
ANTERIOR VESICOUR/URETHROPOXY
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51841
|
| Hospital Charge Code |
76102074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.33 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,238.97
|
| Rate for Payer: Ambetter Exchange |
$757.54
|
| Rate for Payer: Anthem Medicaid |
$686.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.05
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,150.76
|
| Rate for Payer: Healthspan PPO |
$990.67
|
| Rate for Payer: Humana Medicaid |
$686.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,064.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.06
|
| Rate for Payer: Molina Healthcare Passport |
$686.33
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.80
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.54
|
|
|
ANTERIOR VESICOUR/URETHROPOXY
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51841
|
| Hospital Charge Code |
76102074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
ANTERIOR VESICOUR/URETHROPOXY
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 51841
|
| Hospital Charge Code |
76102074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
ANTHOLOGY C SO CLR HA SZ 10
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 10
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
ANTHOLOGY C SO CLR HA SZ 11
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
