|
LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
76102157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| 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 |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
LYSIS OF LABIAL ADHESIONS(P
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 56441
|
| Hospital Charge Code |
761P2157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.89 |
| Max. Negotiated Rate |
$215.71 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: Ambetter Exchange |
$144.91
|
| Rate for Payer: Anthem Medicaid |
$107.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.89
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$202.11
|
| Rate for Payer: Healthspan PPO |
$215.71
|
| Rate for Payer: Humana Medicaid |
$107.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.05
|
| Rate for Payer: Molina Healthcare Passport |
$107.89
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.38
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.91
|
|
|
LYSIS OF PENILE ADHESIONS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$314.61 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$95.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LYSIS OF PENILE ADHESIONS
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
|
|
LYSIS OF PENILE ADHESIONS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 55899
|
| Hospital Charge Code |
76102846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.75
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
LYSIS PENIL CIRCUMIC LESION
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
76102952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| 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 |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$165.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LYSIS PENIL CIRCUMIC LESION
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
76102952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
LYSIS PENIL CIRCUMIC LESION
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 54162
|
| Hospital Charge Code |
76102952
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.21 |
| Max. Negotiated Rate |
$433.08 |
| Rate for Payer: Aetna Commercial |
$317.20
|
| Rate for Payer: Ambetter Exchange |
$189.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.21
|
| Rate for Payer: Anthem Medicaid |
$165.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$189.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$189.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$227.65
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$433.08
|
| Rate for Payer: Healthspan PPO |
$414.92
|
| Rate for Payer: Humana Medicaid |
$165.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$189.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.27
|
| Rate for Payer: Molina Healthcare Passport |
$165.95
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$246.62
|
| Rate for Payer: UHCCP Medicaid |
$115.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$189.71
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,580.74 |
| Rate for Payer: Aetna Commercial |
$1,580.74
|
| Rate for Payer: Ambetter Exchange |
$1,039.78
|
| Rate for Payer: Anthem Medicaid |
$631.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,039.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,039.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,247.74
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,466.69
|
| Rate for Payer: Healthspan PPO |
$1,333.07
|
| Rate for Payer: Humana Medicaid |
$631.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,039.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.63
|
| Rate for Payer: Molina Healthcare Passport |
$631.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,351.71
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,039.78
|
|
|
LYSIS PERINEAL ADHES;SEP PROC
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
76101802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
LYSIS PERINEAL ADHES;SEP PRO(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
761P1802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,580.74 |
| Rate for Payer: Aetna Commercial |
$1,580.74
|
| Rate for Payer: Ambetter Exchange |
$1,039.78
|
| Rate for Payer: Anthem Medicaid |
$631.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,039.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,039.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,247.74
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,466.69
|
| Rate for Payer: Healthspan PPO |
$1,333.07
|
| Rate for Payer: Humana Medicaid |
$631.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,396.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,039.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.63
|
| Rate for Payer: Molina Healthcare Passport |
$631.99
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,351.71
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,039.78
|
|
|
M2A MAGNUM MOD HD SZ 46MM
|
Facility
|
IP
|
$8,642.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.87 |
| Max. Negotiated Rate |
$8,297.18 |
| Rate for Payer: Aetna Commercial |
$6,655.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,741.46
|
| Rate for Payer: Cash Price |
$4,321.45
|
| Rate for Payer: Cigna Commercial |
$7,173.61
|
| Rate for Payer: First Health Commercial |
$8,210.75
|
| Rate for Payer: Humana Commercial |
$7,346.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,087.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,378.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,605.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,482.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,914.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,519.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,963.60
|
| Rate for Payer: PHCS Commercial |
$8,297.18
|
| Rate for Payer: United Healthcare All Payer |
$7,605.75
|
|
|
M2A MAGNUM MOD HD SZ 46MM
|
Facility
|
OP
|
$8,642.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,592.87 |
| Max. Negotiated Rate |
$8,297.18 |
| Rate for Payer: Aetna Commercial |
$6,655.03
|
| Rate for Payer: Anthem Medicaid |
$2,972.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,741.46
|
| Rate for Payer: Cash Price |
$4,321.45
|
| Rate for Payer: Cigna Commercial |
$7,173.61
|
| Rate for Payer: First Health Commercial |
$8,210.75
|
| Rate for Payer: Humana Commercial |
$7,346.47
|
| Rate for Payer: Humana KY Medicaid |
$2,972.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,002.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,087.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,378.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,031.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,605.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,482.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,914.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,519.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,963.60
|
| Rate for Payer: PHCS Commercial |
$8,297.18
|
| Rate for Payer: United Healthcare All Payer |
$7,605.75
|
|
|
M2A MAGNUM PF CUP 520DX461D
|
Facility
|
OP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem Medicaid |
$6,978.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Humana KY Medicaid |
$6,978.59
|
| Rate for Payer: Kentucky WC Medicaid |
$7,049.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,118.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
M2A MAGNUM PF CUP 520DX461D
|
Facility
|
IP
|
$20,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,087.75 |
| Max. Negotiated Rate |
$19,480.80 |
| Rate for Payer: Aetna Commercial |
$15,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,828.15
|
| Rate for Payer: Cash Price |
$10,146.25
|
| Rate for Payer: Cigna Commercial |
$16,842.78
|
| Rate for Payer: First Health Commercial |
$19,277.88
|
| Rate for Payer: Humana Commercial |
$17,248.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,639.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,975.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,087.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,857.40
|
| Rate for Payer: Ohio Health Group HMO |
$15,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,654.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,001.83
|
| Rate for Payer: PHCS Commercial |
$19,480.80
|
| Rate for Payer: United Healthcare All Payer |
$17,857.40
|
|
|
MA2-MAGNUM 42-50 TPR INSRT-6
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$3,460.80 |
| Rate for Payer: Aetna Commercial |
$2,775.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.90
|
| Rate for Payer: Cash Price |
$1,802.50
|
| Rate for Payer: Cigna Commercial |
$2,992.15
|
| Rate for Payer: First Health Commercial |
$3,424.75
|
| Rate for Payer: Humana Commercial |
$3,064.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,956.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,660.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,172.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,884.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,136.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,487.45
|
| Rate for Payer: PHCS Commercial |
$3,460.80
|
| Rate for Payer: United Healthcare All Payer |
$3,172.40
|
|
|
MA2-MAGNUM 42-50 TPR INSRT-6
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$3,460.80 |
| Rate for Payer: Aetna Commercial |
$2,775.85
|
| Rate for Payer: Anthem Medicaid |
$1,239.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.90
|
| Rate for Payer: Cash Price |
$1,802.50
|
| Rate for Payer: Cigna Commercial |
$2,992.15
|
| Rate for Payer: First Health Commercial |
$3,424.75
|
| Rate for Payer: Humana Commercial |
$3,064.25
|
| Rate for Payer: Humana KY Medicaid |
$1,239.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,252.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,956.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,660.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,172.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,884.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,136.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,487.45
|
| Rate for Payer: PHCS Commercial |
$3,460.80
|
| Rate for Payer: United Healthcare All Payer |
$3,172.40
|
|
|
MAC 30 5F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 30 5F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.5 5F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.5 5F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.5 6F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.5 6F
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
MAC 3.75 5F
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
