|
PEG 1 SER A PAT W/WR THN 34
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SR A PT W/WR THN .37X8.6
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SR A PT W/WR THN .37X8.6
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEGASYS 180MCG/0.5ML KIT
|
Facility
|
IP
|
$5,567.12
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25001168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$723.73 |
| Max. Negotiated Rate |
$5,344.44 |
| Rate for Payer: Aetna Commercial |
$4,286.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,783.56
|
| Rate for Payer: Cigna Commercial |
$4,620.71
|
| Rate for Payer: First Health Commercial |
$5,288.76
|
| Rate for Payer: Humana Commercial |
$4,732.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.81
|
| Rate for Payer: PHCS Commercial |
$5,344.44
|
| Rate for Payer: United Healthcare All Payer |
$4,899.07
|
|
|
PEGASYS 180MCG/0.5ML KIT
|
Facility
|
OP
|
$5,567.12
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25001168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$723.73 |
| Max. Negotiated Rate |
$5,344.44 |
| Rate for Payer: Aetna Commercial |
$4,286.68
|
| Rate for Payer: Anthem Medicaid |
$1,914.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,783.56
|
| Rate for Payer: Cigna Commercial |
$4,620.71
|
| Rate for Payer: First Health Commercial |
$5,288.76
|
| Rate for Payer: Humana Commercial |
$4,732.05
|
| Rate for Payer: Humana KY Medicaid |
$1,914.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,934.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.81
|
| Rate for Payer: PHCS Commercial |
$5,344.44
|
| Rate for Payer: United Healthcare All Payer |
$4,899.07
|
|
|
PEGASYS 180MCG/ML VIAL (1ML)
|
Facility
|
IP
|
$5,567.12
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$723.73 |
| Max. Negotiated Rate |
$5,344.44 |
| Rate for Payer: Aetna Commercial |
$4,286.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,783.56
|
| Rate for Payer: Cigna Commercial |
$4,620.71
|
| Rate for Payer: First Health Commercial |
$5,288.76
|
| Rate for Payer: Humana Commercial |
$4,732.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.81
|
| Rate for Payer: PHCS Commercial |
$5,344.44
|
| Rate for Payer: United Healthcare All Payer |
$4,899.07
|
|
|
PEGASYS 180MCG/ML VIAL (1ML)
|
Facility
|
OP
|
$5,567.12
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25003656
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$723.73 |
| Max. Negotiated Rate |
$5,344.44 |
| Rate for Payer: Aetna Commercial |
$4,286.68
|
| Rate for Payer: Anthem Medicaid |
$1,914.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.35
|
| Rate for Payer: Cash Price |
$2,783.56
|
| Rate for Payer: Cigna Commercial |
$4,620.71
|
| Rate for Payer: First Health Commercial |
$5,288.76
|
| Rate for Payer: Humana Commercial |
$4,732.05
|
| Rate for Payer: Humana KY Medicaid |
$1,914.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,934.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,565.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,899.07
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.81
|
| Rate for Payer: PHCS Commercial |
$5,344.44
|
| Rate for Payer: United Healthcare All Payer |
$4,899.07
|
|
|
PEGGED GLENOID 40MM
|
Facility
|
IP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
PEGGED GLENOID 40MM
|
Facility
|
OP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem Medicaid |
$3,126.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Humana KY Medicaid |
$3,126.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
PEGGED GLENOID 46MM
|
Facility
|
IP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
PEGGED GLENOID 46MM
|
Facility
|
OP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem Medicaid |
$3,126.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Humana KY Medicaid |
$3,126.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
PELVIC & BREAST EXAM
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
51000159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.88
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PELVIC & BREAST EXAM
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
51000159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$33.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$33.01
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$33.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PELVIC & BREAST EXAM
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
51000159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.57
|
| Rate for Payer: Anthem Medicaid |
$22.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Humana Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.39
|
| Rate for Payer: Molina Healthcare Passport |
$22.93
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.20
|
| Rate for Payer: UHCCP Medicaid |
$22.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.16
|
|
|
PELVIC & BREAST EXAM (P
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510P0159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$53.63 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.57
|
| Rate for Payer: Anthem Medicaid |
$22.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Humana Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.39
|
| Rate for Payer: Molina Healthcare Passport |
$22.93
|
| Rate for Payer: Multiplan PHCS |
$27.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.20
|
| Rate for Payer: UHCCP Medicaid |
$22.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.16
|
|
|
PELVIC & BREAST EXAM (T
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510T0159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
PELVIC & BREAST EXAM (T
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510T0159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$25,427.22
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$17,254.18 |
| Max. Negotiated Rate |
$25,427.22 |
| Rate for Payer: Anthem Medicaid |
$17,254.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,162.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25,427.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,519.10
|
| Rate for Payer: Humana KY Medicaid |
$17,254.18
|
| Rate for Payer: Humana Medicare Advantage |
$18,162.30
|
| Rate for Payer: Kentucky WC Medicaid |
$17,426.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,794.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,599.27
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$14,742.07
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$10,003.55 |
| Max. Negotiated Rate |
$14,742.07 |
| Rate for Payer: Anthem Medicaid |
$10,003.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,530.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,742.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,215.57
|
| Rate for Payer: Humana KY Medicaid |
$10,003.55
|
| Rate for Payer: Humana Medicare Advantage |
$10,530.05
|
| Rate for Payer: Kentucky WC Medicaid |
$10,103.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,636.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,203.62
|
|
|
PELVIC EXAMINATION
|
Professional
|
Both
|
$4,271.98
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$4,271.98 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Anthem Medicaid |
$28.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,271.98
|
| Rate for Payer: Cash Price |
$2,135.99
|
| Rate for Payer: Cash Price |
$2,135.99
|
| Rate for Payer: Cigna Commercial |
$156.50
|
| Rate for Payer: Healthspan PPO |
$156.35
|
| Rate for Payer: Humana Medicaid |
$28.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.74
|
| Rate for Payer: Molina Healthcare Passport |
$28.18
|
| Rate for Payer: Multiplan PHCS |
$2,563.19
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,990.39
|
| Rate for Payer: UHCCP Medicaid |
$1,495.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.46
|
|
|
PELVIC EXAMINATION
|
Facility
|
OP
|
$4,271.98
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.36 |
| Max. Negotiated Rate |
$4,101.10 |
| Rate for Payer: Aetna Commercial |
$3,289.42
|
| Rate for Payer: Anthem Medicaid |
$1,469.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,135.99
|
| Rate for Payer: Cash Price |
$2,135.99
|
| Rate for Payer: Cigna Commercial |
$3,545.74
|
| Rate for Payer: First Health Commercial |
$4,058.38
|
| Rate for Payer: Humana Commercial |
$3,631.18
|
| Rate for Payer: Humana KY Medicaid |
$1,469.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,498.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,203.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.31
|
| Rate for Payer: PHCS Commercial |
$4,101.10
|
| Rate for Payer: United Healthcare All Payer |
$3,759.34
|
|
|
PELVIC EXAMINATION
|
Facility
|
IP
|
$4,271.98
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.36 |
| Max. Negotiated Rate |
$4,101.10 |
| Rate for Payer: Aetna Commercial |
$3,289.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.14
|
| Rate for Payer: Cash Price |
$2,135.99
|
| Rate for Payer: Cigna Commercial |
$3,545.74
|
| Rate for Payer: First Health Commercial |
$4,058.38
|
| Rate for Payer: Humana Commercial |
$3,631.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,203.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.31
|
| Rate for Payer: PHCS Commercial |
$4,101.10
|
| Rate for Payer: United Healthcare All Payer |
$3,759.34
|
|
|
PELVIC EXAMINATION(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
761P2191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Anthem Medicaid |
$28.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$156.50
|
| Rate for Payer: Healthspan PPO |
$156.35
|
| Rate for Payer: Humana Medicaid |
$28.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.74
|
| Rate for Payer: Molina Healthcare Passport |
$28.18
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.46
|
|
|
PELVIC EXAMINATION(T
|
Facility
|
IP
|
$3,796.98
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
761T2191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.61 |
| Max. Negotiated Rate |
$3,645.10 |
| Rate for Payer: Aetna Commercial |
$2,923.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.64
|
| Rate for Payer: Cash Price |
$1,898.49
|
| Rate for Payer: Cigna Commercial |
$3,151.49
|
| Rate for Payer: First Health Commercial |
$3,607.13
|
| Rate for Payer: Humana Commercial |
$3,227.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,847.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.06
|
| Rate for Payer: PHCS Commercial |
$3,645.10
|
| Rate for Payer: United Healthcare All Payer |
$3,341.34
|
|
|
PELVIC EXAMINATION(T
|
Facility
|
OP
|
$3,796.98
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
761T2191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.61 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,923.67
|
| Rate for Payer: Anthem Medicaid |
$1,305.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,961.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$1,898.49
|
| Rate for Payer: Cash Price |
$1,898.49
|
| Rate for Payer: Cigna Commercial |
$3,151.49
|
| Rate for Payer: First Health Commercial |
$3,607.13
|
| Rate for Payer: Humana Commercial |
$3,227.43
|
| Rate for Payer: Humana KY Medicaid |
$1,305.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,113.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,331.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,847.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.06
|
| Rate for Payer: PHCS Commercial |
$3,645.10
|
| Rate for Payer: United Healthcare All Payer |
$3,341.34
|
|
