|
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 |
$1,670.14 |
| 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 |
$4,453.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,843.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.31
|
| Rate for Payer: PHCS Commercial |
$5,344.44
|
| Rate for Payer: United Healthcare All Payer |
$4,899.07
|
|
|
PEGGED GLENOID 40MM
|
Facility
|
IP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
PEGGED GLENOID 40MM
|
Facility
|
OP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem Medicaid |
$3,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Humana KY Medicaid |
$3,195.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,259.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
PEGGED GLENOID 46MM
|
Facility
|
IP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
PEGGED GLENOID 46MM
|
Facility
|
OP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem Medicaid |
$3,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Humana KY Medicaid |
$3,195.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,259.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
PELVIC & BREAST EXAM
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
51000159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.01 |
| Max. Negotiated Rate |
$119.66 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$33.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| 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 |
$85.47
|
| 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 |
$102.56
|
| 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 |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PELVIC & BREAST EXAM
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
51000159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.80 |
| 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 |
$76.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.24
|
| 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 |
$57.60 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Ambetter Exchange |
$25.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.57
|
| Rate for Payer: Anthem Medicaid |
$31.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.48
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Humana Medicaid |
$31.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.63
|
| Rate for Payer: Molina Healthcare Passport |
$31.99
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.02
|
| Rate for Payer: UHCCP Medicaid |
$22.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.40
|
|
|
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: Ambetter Exchange |
$25.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.57
|
| Rate for Payer: Anthem Medicaid |
$31.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.48
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Humana Medicaid |
$31.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.63
|
| Rate for Payer: Molina Healthcare Passport |
$31.99
|
| Rate for Payer: Multiplan PHCS |
$27.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.02
|
| Rate for Payer: UHCCP Medicaid |
$22.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.40
|
|
|
PELVIC & BREAST EXAM (T
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
510T0159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.00 |
| 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 |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| 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 |
$17.20 |
| Max. Negotiated Rate |
$119.66 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| 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 |
$85.47
|
| 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 |
$102.56
|
| 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 |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
PELVIC EXAMINATION
|
Professional
|
Both
|
$4,382.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$2,629.20 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Ambetter Exchange |
$100.14
|
| Rate for Payer: Anthem Medicaid |
$28.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.17
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cash Price |
$2,191.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.74
|
| Rate for Payer: Molina Healthcare Passport |
$28.18
|
| Rate for Payer: Multiplan PHCS |
$2,629.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.18
|
| Rate for Payer: UHCCP Medicaid |
$1,533.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.14
|
|
|
PELVIC EXAMINATION
|
Facility
|
IP
|
$4,382.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,314.60 |
| Max. Negotiated Rate |
$4,206.72 |
| Rate for Payer: Aetna Commercial |
$3,374.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.96
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,637.06
|
| Rate for Payer: First Health Commercial |
$4,162.90
|
| Rate for Payer: Humana Commercial |
$3,724.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.58
|
| Rate for Payer: PHCS Commercial |
$4,206.72
|
| Rate for Payer: United Healthcare All Payer |
$3,856.16
|
|
|
PELVIC EXAMINATION
|
Facility
|
OP
|
$4,382.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
76102191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,506.97 |
| Max. Negotiated Rate |
$4,206.72 |
| Rate for Payer: Aetna Commercial |
$3,374.14
|
| Rate for Payer: Anthem Medicaid |
$1,506.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,417.96
|
| 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 |
$2,191.00
|
| Rate for Payer: Cash Price |
$2,191.00
|
| Rate for Payer: Cigna Commercial |
$3,637.06
|
| Rate for Payer: First Health Commercial |
$4,162.90
|
| Rate for Payer: Humana Commercial |
$3,724.70
|
| Rate for Payer: Humana KY Medicaid |
$1,506.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,505.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,812.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.58
|
| Rate for Payer: PHCS Commercial |
$4,206.72
|
| Rate for Payer: United Healthcare All Payer |
$3,856.16
|
|
|
PELVIC EXAMINATION
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 99459
|
| Hospital Charge Code |
51000366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Ambetter Exchange |
$18.86
|
| Rate for Payer: Anthem Medicaid |
$17.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Humana Medicaid |
$17.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.04
|
| Rate for Payer: Molina Healthcare Passport |
$17.69
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.52
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.86
|
|
|
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 |
$285.00 |
| Rate for Payer: Aetna Commercial |
$161.47
|
| Rate for Payer: Ambetter Exchange |
$100.14
|
| Rate for Payer: Anthem Medicaid |
$28.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.14
|
| 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 |
$130.18
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.14
|
|
|
PELVIC EXAMINATION(T
|
Facility
|
OP
|
$3,907.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
761T2191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,343.62 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$3,008.39
|
| Rate for Payer: Anthem Medicaid |
$1,343.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.46
|
| 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 |
$1,953.50
|
| Rate for Payer: Cash Price |
$1,953.50
|
| Rate for Payer: Cigna Commercial |
$3,242.81
|
| Rate for Payer: First Health Commercial |
$3,711.65
|
| Rate for Payer: Humana Commercial |
$3,320.95
|
| Rate for Payer: Humana KY Medicaid |
$1,343.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.83
|
| Rate for Payer: PHCS Commercial |
$3,750.72
|
| Rate for Payer: United Healthcare All Payer |
$3,438.16
|
|
|
PELVIC EXAMINATION(T
|
Facility
|
IP
|
$3,907.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
761T2191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,172.10 |
| Max. Negotiated Rate |
$3,750.72 |
| Rate for Payer: Aetna Commercial |
$3,008.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.46
|
| Rate for Payer: Cash Price |
$1,953.50
|
| Rate for Payer: Cigna Commercial |
$3,242.81
|
| Rate for Payer: First Health Commercial |
$3,711.65
|
| Rate for Payer: Humana Commercial |
$3,320.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.83
|
| Rate for Payer: PHCS Commercial |
$3,750.72
|
| Rate for Payer: United Healthcare All Payer |
$3,438.16
|
|
|
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 57410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
PELVIC ULTRASOUND NON OB
|
Facility
|
IP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
40200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$305.40 |
| Max. Negotiated Rate |
$977.28 |
| Rate for Payer: Aetna Commercial |
$783.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.04
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$844.94
|
| Rate for Payer: First Health Commercial |
$967.10
|
| Rate for Payer: Humana Commercial |
$865.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.84
|
| Rate for Payer: Ohio Health Group HMO |
$763.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.42
|
| Rate for Payer: PHCS Commercial |
$977.28
|
| Rate for Payer: United Healthcare All Payer |
$895.84
|
|
|
PELVIC ULTRASOUND NON OB
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
40200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$610.80 |
| Rate for Payer: Aetna Commercial |
$183.42
|
| Rate for Payer: Ambetter Exchange |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.65
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$155.61
|
| Rate for Payer: Healthspan PPO |
$171.87
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$610.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.12
|
| Rate for Payer: UHCCP Medicaid |
$356.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.71
|
|
|
PELVIC ULTRASOUND NON OB
|
Facility
|
OP
|
$1,018.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
40200046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$977.28 |
| Rate for Payer: Aetna Commercial |
$783.86
|
| Rate for Payer: Anthem Medicaid |
$350.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$794.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cash Price |
$509.00
|
| Rate for Payer: Cigna Commercial |
$844.94
|
| Rate for Payer: First Health Commercial |
$967.10
|
| Rate for Payer: Humana Commercial |
$865.30
|
| Rate for Payer: Humana KY Medicaid |
$350.09
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$353.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$834.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$751.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$357.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$895.84
|
| Rate for Payer: Ohio Health Group HMO |
$763.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.42
|
| Rate for Payer: PHCS Commercial |
$977.28
|
| Rate for Payer: United Healthcare All Payer |
$895.84
|
|
|
PELVIC ULTRASOUND NON OB(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
402P0046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$183.42 |
| Rate for Payer: Aetna Commercial |
$183.42
|
| Rate for Payer: Ambetter Exchange |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.65
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$155.61
|
| Rate for Payer: Healthspan PPO |
$171.87
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$123.12
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.71
|
|
|
PELVIC ULTRASOUND NON OB(T
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
402T0046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$267.90 |
| Max. Negotiated Rate |
$857.28 |
| Rate for Payer: Aetna Commercial |
$687.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$696.54
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$741.19
|
| Rate for Payer: First Health Commercial |
$848.35
|
| Rate for Payer: Humana Commercial |
$759.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$732.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$785.84
|
| Rate for Payer: Ohio Health Group HMO |
$669.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.17
|
| Rate for Payer: PHCS Commercial |
$857.28
|
| Rate for Payer: United Healthcare All Payer |
$785.84
|
|
|
PELVIC ULTRASOUND NON OB(T
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
402T0046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$857.28 |
| Rate for Payer: Aetna Commercial |
$687.61
|
| Rate for Payer: Anthem Medicaid |
$307.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$696.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cash Price |
$446.50
|
| Rate for Payer: Cigna Commercial |
$741.19
|
| Rate for Payer: First Health Commercial |
$848.35
|
| Rate for Payer: Humana Commercial |
$759.05
|
| Rate for Payer: Humana KY Medicaid |
$307.10
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$310.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$732.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$785.84
|
| Rate for Payer: Ohio Health Group HMO |
$669.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$776.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.17
|
| Rate for Payer: PHCS Commercial |
$857.28
|
| Rate for Payer: United Healthcare All Payer |
$785.84
|
|
