|
OPEN AORTIC TUBE PROSTH REPR
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem Medicaid |
$701.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Humana KY Medicaid |
$701.56
|
| Rate for Payer: Kentucky WC Medicaid |
$708.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.40
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
36001271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Aetna Commercial |
$1,570.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$1,693.20
|
| Rate for Payer: First Health Commercial |
$1,938.00
|
| Rate for Payer: Humana Commercial |
$1,734.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.40
|
| Rate for Payer: PHCS Commercial |
$1,958.40
|
| Rate for Payer: United Healthcare All Payer |
$1,795.20
|
|
|
OPEN AORTIC TUBE PROSTH REPR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 34830
|
| Hospital Charge Code |
360P1271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.00 |
| Max. Negotiated Rate |
$3,224.64 |
| Rate for Payer: Aetna Commercial |
$3,224.64
|
| Rate for Payer: Anthem Medicaid |
$1,378.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,040.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cash Price |
$1,020.00
|
| Rate for Payer: Cigna Commercial |
$3,083.04
|
| Rate for Payer: Healthspan PPO |
$3,170.45
|
| Rate for Payer: Humana Medicaid |
$1,378.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,477.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,406.25
|
| Rate for Payer: Molina Healthcare Passport |
$1,378.68
|
| Rate for Payer: Multiplan PHCS |
$1,224.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,428.00
|
| Rate for Payer: UHCCP Medicaid |
$714.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,392.47
|
|
|
OPENBIOMEFECMICROBIOME CAP(30)
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOMEFECMICROBIOME CAP(30)
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25002466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (250mL)
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (250mL)
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$88.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.03
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Humana Medicare Advantage |
$62.98
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPENBIOME FMT 1mL (30mL)
|
Facility
|
OP
|
$2,220.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$2,131.20 |
| Rate for Payer: Aetna Commercial |
$1,709.40
|
| Rate for Payer: Anthem Medicaid |
$763.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,731.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$88.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$85.03
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,842.60
|
| Rate for Payer: First Health Commercial |
$2,109.00
|
| Rate for Payer: Humana Commercial |
$1,887.00
|
| Rate for Payer: Humana KY Medicaid |
$763.46
|
| Rate for Payer: Humana Medicare Advantage |
$62.98
|
| Rate for Payer: Kentucky WC Medicaid |
$771.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,820.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,638.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,953.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,665.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$688.20
|
| Rate for Payer: PHCS Commercial |
$2,131.20
|
| Rate for Payer: United Healthcare All Payer |
$1,953.60
|
|
|
OPENBIOME FMT 1mL (30mL)
|
Facility
|
IP
|
$2,220.00
|
|
|
Service Code
|
HCPCS J1440
|
| Hospital Charge Code |
25003317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.60 |
| Max. Negotiated Rate |
$2,131.20 |
| Rate for Payer: Aetna Commercial |
$1,709.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,731.60
|
| Rate for Payer: Cash Price |
$1,110.00
|
| Rate for Payer: Cigna Commercial |
$1,842.60
|
| Rate for Payer: First Health Commercial |
$2,109.00
|
| Rate for Payer: Humana Commercial |
$1,887.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,820.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,638.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,953.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,665.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$688.20
|
| Rate for Payer: PHCS Commercial |
$2,131.20
|
| Rate for Payer: United Healthcare All Payer |
$1,953.60
|
|
|
OPEN BIOPSY OF LUNG PLEURA
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
OPEN BIOPSY OF LUNG PLEURA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.63 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Anthem Medicaid |
$616.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,431.07
|
| Rate for Payer: Healthspan PPO |
$765.54
|
| Rate for Payer: Humana Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.96
|
| Rate for Payer: Molina Healthcare Passport |
$616.63
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.80
|
|
|
OPEN BIOPSY OF LUNG PLEURA
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
OPEN BIOPSY OF LUNG PLEURA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
761P1173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.63 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Anthem Medicaid |
$616.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,431.07
|
| Rate for Payer: Healthspan PPO |
$765.54
|
| Rate for Payer: Humana Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.96
|
| Rate for Payer: Molina Healthcare Passport |
$616.63
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.80
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Facility
|
IP
|
$6,333.77
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.39 |
| Max. Negotiated Rate |
$6,080.42 |
| Rate for Payer: Aetna Commercial |
$4,877.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,940.34
|
| Rate for Payer: Cash Price |
$3,166.89
|
| Rate for Payer: Cigna Commercial |
$5,257.03
|
| Rate for Payer: First Health Commercial |
$6,017.08
|
| Rate for Payer: Humana Commercial |
$5,383.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,193.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,674.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,900.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,573.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,750.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,266.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$823.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,963.47
|
| Rate for Payer: PHCS Commercial |
$6,080.42
|
| Rate for Payer: United Healthcare All Payer |
$5,573.72
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Facility
|
OP
|
$6,333.77
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$823.39 |
| Max. Negotiated Rate |
$6,080.42 |
| Rate for Payer: Aetna Commercial |
$4,877.00
|
| Rate for Payer: Anthem Medicaid |
$2,178.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,940.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$3,166.89
|
| Rate for Payer: Cash Price |
$3,166.89
|
| Rate for Payer: Cigna Commercial |
$5,257.03
|
| Rate for Payer: First Health Commercial |
$6,017.08
|
| Rate for Payer: Humana Commercial |
$5,383.70
|
| Rate for Payer: Humana KY Medicaid |
$2,178.18
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,200.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,193.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,674.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,221.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,573.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,750.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,266.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$823.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,963.47
|
| Rate for Payer: PHCS Commercial |
$6,080.42
|
| Rate for Payer: United Healthcare All Payer |
$5,573.72
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Professional
|
Both
|
$6,333.77
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.70 |
| Max. Negotiated Rate |
$6,333.77 |
| Rate for Payer: Anthem Medicaid |
$350.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,333.77
|
| Rate for Payer: Cash Price |
$3,166.89
|
| Rate for Payer: Cash Price |
$3,166.89
|
| Rate for Payer: Cigna Commercial |
$721.01
|
| Rate for Payer: Humana Medicaid |
$350.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$562.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.71
|
| Rate for Payer: Molina Healthcare Passport |
$350.70
|
| Rate for Payer: Multiplan PHCS |
$3,800.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,433.64
|
| Rate for Payer: UHCCP Medicaid |
$2,216.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.21
|
|
|
OPEN BX/EXC INGUINOFEM NODES(P
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761P1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$721.01 |
| Rate for Payer: Anthem Medicaid |
$350.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$721.01
|
| Rate for Payer: Humana Medicaid |
$350.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$562.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.71
|
| Rate for Payer: Molina Healthcare Passport |
$350.70
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.21
|
|
|
OPEN BX/EXC INGUINOFEM NODES(T
|
Facility
|
OP
|
$5,693.77
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761T1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.19 |
| Max. Negotiated Rate |
$5,466.02 |
| Rate for Payer: Aetna Commercial |
$4,384.20
|
| Rate for Payer: Anthem Medicaid |
$1,958.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,846.89
|
| Rate for Payer: Cash Price |
$2,846.89
|
| Rate for Payer: Cigna Commercial |
$4,725.83
|
| Rate for Payer: First Health Commercial |
$5,409.08
|
| Rate for Payer: Humana Commercial |
$4,839.70
|
| Rate for Payer: Humana KY Medicaid |
$1,958.09
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,978.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,765.07
|
| Rate for Payer: PHCS Commercial |
$5,466.02
|
| Rate for Payer: United Healthcare All Payer |
$5,010.52
|
|
|
OPEN BX/EXC INGUINOFEM NODES(T
|
Facility
|
IP
|
$5,693.77
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761T1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.19 |
| Max. Negotiated Rate |
$5,466.02 |
| Rate for Payer: Aetna Commercial |
$4,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.14
|
| Rate for Payer: Cash Price |
$2,846.89
|
| Rate for Payer: Cigna Commercial |
$4,725.83
|
| Rate for Payer: First Health Commercial |
$5,409.08
|
| Rate for Payer: Humana Commercial |
$4,839.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,138.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,765.07
|
| Rate for Payer: PHCS Commercial |
$5,466.02
|
| Rate for Payer: United Healthcare All Payer |
$5,010.52
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.62 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,807.44
|
| Rate for Payer: Anthem Medicaid |
$706.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,681.50
|
| Rate for Payer: Healthspan PPO |
$1,524.24
|
| Rate for Payer: Humana Medicaid |
$706.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,599.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.75
|
| Rate for Payer: Molina Healthcare Passport |
$706.62
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.69
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OPEN CHOLECYST EXPLOR DUCT(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
761P1969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.62 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,807.44
|
| Rate for Payer: Anthem Medicaid |
$706.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,681.50
|
| Rate for Payer: Healthspan PPO |
$1,524.24
|
| Rate for Payer: Humana Medicaid |
$706.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,599.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.75
|
| Rate for Payer: Molina Healthcare Passport |
$706.62
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.69
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
76101947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
76101947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
