|
SURG DX EXAM ANORECTAL(P
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
761P1909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$157.23
|
| Rate for Payer: Anthem Medicaid |
$77.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$148.84
|
| Rate for Payer: Healthspan PPO |
$132.60
|
| Rate for Payer: Humana Medicaid |
$77.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.53
|
| Rate for Payer: Molina Healthcare Passport |
$77.97
|
| Rate for Payer: Multiplan PHCS |
$198.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$231.00
|
| Rate for Payer: UHCCP Medicaid |
$115.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.75
|
|
|
SURGERY OF BREAST CAPSULE
|
Facility
|
IP
|
$6,352.83
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.87 |
| Max. Negotiated Rate |
$6,098.72 |
| Rate for Payer: Aetna Commercial |
$4,891.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,955.21
|
| Rate for Payer: Cash Price |
$3,176.42
|
| Rate for Payer: Cigna Commercial |
$5,272.85
|
| Rate for Payer: First Health Commercial |
$6,035.19
|
| Rate for Payer: Humana Commercial |
$5,399.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,209.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,688.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,905.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,590.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,270.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$825.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.38
|
| Rate for Payer: PHCS Commercial |
$6,098.72
|
| Rate for Payer: United Healthcare All Payer |
$5,590.49
|
|
|
SURGERY OF BREAST CAPSULE
|
Facility
|
OP
|
$6,352.83
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.87 |
| Max. Negotiated Rate |
$6,098.72 |
| Rate for Payer: Aetna Commercial |
$4,891.68
|
| Rate for Payer: Anthem Medicaid |
$2,184.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,955.21
|
| 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 |
$3,176.42
|
| Rate for Payer: Cash Price |
$3,176.42
|
| Rate for Payer: Cigna Commercial |
$5,272.85
|
| Rate for Payer: First Health Commercial |
$6,035.19
|
| Rate for Payer: Humana Commercial |
$5,399.91
|
| Rate for Payer: Humana KY Medicaid |
$2,184.74
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,206.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,209.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,688.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,228.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,590.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,270.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$825.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.38
|
| Rate for Payer: PHCS Commercial |
$6,098.72
|
| Rate for Payer: United Healthcare All Payer |
$5,590.49
|
|
|
SURGERY OF BREAST CAPSULE
|
Professional
|
Both
|
$6,352.83
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.12 |
| Max. Negotiated Rate |
$6,352.83 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Anthem Medicaid |
$417.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,352.83
|
| Rate for Payer: Cash Price |
$3,176.42
|
| Rate for Payer: Cash Price |
$3,176.42
|
| Rate for Payer: Cigna Commercial |
$932.87
|
| Rate for Payer: Healthspan PPO |
$783.68
|
| Rate for Payer: Humana Medicaid |
$417.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$878.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.46
|
| Rate for Payer: Molina Healthcare Passport |
$417.12
|
| Rate for Payer: Multiplan PHCS |
$3,811.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,446.98
|
| Rate for Payer: UHCCP Medicaid |
$2,223.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.29
|
|
|
SURGERY OF BREAST CAPSULE(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
761P0321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.12 |
| Max. Negotiated Rate |
$1,475.00 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Anthem Medicaid |
$417.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,475.00
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$932.87
|
| Rate for Payer: Healthspan PPO |
$783.68
|
| Rate for Payer: Humana Medicaid |
$417.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$878.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.46
|
| Rate for Payer: Molina Healthcare Passport |
$417.12
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,032.50
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.29
|
|
|
SURGERY OF BREAST CAPSULE(T
|
Facility
|
OP
|
$4,877.83
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
761T0321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.12 |
| Max. Negotiated Rate |
$4,682.72 |
| Rate for Payer: Aetna Commercial |
$3,755.93
|
| Rate for Payer: Anthem Medicaid |
$1,677.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.71
|
| 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 |
$2,438.92
|
| Rate for Payer: Cash Price |
$2,438.92
|
| Rate for Payer: Cigna Commercial |
$4,048.60
|
| Rate for Payer: First Health Commercial |
$4,633.94
|
| Rate for Payer: Humana Commercial |
$4,146.16
|
| Rate for Payer: Humana KY Medicaid |
$1,677.49
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,711.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$975.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,512.13
|
| Rate for Payer: PHCS Commercial |
$4,682.72
|
| Rate for Payer: United Healthcare All Payer |
$4,292.49
|
|
|
SURGERY OF BREAST CAPSULE(T
|
Facility
|
IP
|
$4,877.83
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
761T0321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.12 |
| Max. Negotiated Rate |
$4,682.72 |
| Rate for Payer: Aetna Commercial |
$3,755.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.71
|
| Rate for Payer: Cash Price |
$2,438.92
|
| Rate for Payer: Cigna Commercial |
$4,048.60
|
| Rate for Payer: First Health Commercial |
$4,633.94
|
| Rate for Payer: Humana Commercial |
$4,146.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,463.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$975.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,512.13
|
| Rate for Payer: PHCS Commercial |
$4,682.72
|
| Rate for Payer: United Healthcare All Payer |
$4,292.49
|
|
|
SURGERY/SPEECH PROSTHESIS
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 31611
|
| Hospital Charge Code |
41000031
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.87 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$814.39
|
| Rate for Payer: Anthem Medicaid |
$345.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$740.58
|
| Rate for Payer: Healthspan PPO |
$635.85
|
| Rate for Payer: Humana Medicaid |
$345.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$680.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.79
|
| Rate for Payer: Molina Healthcare Passport |
$345.87
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.33
|
|
|
SURGERY/SPEECH PROSTHESIS(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 31611
|
| Hospital Charge Code |
410P0031
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$345.87 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$814.39
|
| Rate for Payer: Anthem Medicaid |
$345.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$740.58
|
| Rate for Payer: Healthspan PPO |
$635.85
|
| Rate for Payer: Humana Medicaid |
$345.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$680.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$352.79
|
| Rate for Payer: Molina Healthcare Passport |
$345.87
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.33
|
|
|
SURGERY TO STOP LEG GROWTH
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 27475
|
| Hospital Charge Code |
76100851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,060.85 |
| Rate for Payer: Aetna Commercial |
$959.21
|
| Rate for Payer: Anthem Medicaid |
$476.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,060.85
|
| Rate for Payer: Healthspan PPO |
$868.84
|
| Rate for Payer: Humana Medicaid |
$476.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.97
|
| Rate for Payer: Molina Healthcare Passport |
$476.44
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$481.20
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 27475
|
| Hospital Charge Code |
76100851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$825.60 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 27475
|
| Hospital Charge Code |
76100851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Humana KY Medicaid |
$295.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$298.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
SURGERY TO STOP LEG GROWTH(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 27475
|
| Hospital Charge Code |
761P0851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,060.85 |
| Rate for Payer: Aetna Commercial |
$959.21
|
| Rate for Payer: Anthem Medicaid |
$476.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,060.85
|
| Rate for Payer: Healthspan PPO |
$868.84
|
| Rate for Payer: Humana Medicaid |
$476.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$763.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.97
|
| Rate for Payer: Molina Healthcare Passport |
$476.44
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$481.20
|
|
|
SURGICAL ANAL FISTULA
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 46280
|
| Hospital Charge Code |
76101923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
SURGICAL ANAL FISTULA
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 46280
|
| Hospital Charge Code |
76101923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
SURGICAL ANAL FISTULA
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 46280
|
| Hospital Charge Code |
76101923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.41 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$626.29
|
| Rate for Payer: Anthem Medicaid |
$358.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$564.51
|
| Rate for Payer: Healthspan PPO |
$528.16
|
| Rate for Payer: Humana Medicaid |
$358.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$571.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.58
|
| Rate for Payer: Molina Healthcare Passport |
$358.41
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.99
|
|
|
SURGICAL ANAL FISTULA(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 46280
|
| Hospital Charge Code |
761P1923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.41 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$626.29
|
| Rate for Payer: Anthem Medicaid |
$358.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$564.51
|
| Rate for Payer: Healthspan PPO |
$528.16
|
| Rate for Payer: Humana Medicaid |
$358.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$571.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.58
|
| Rate for Payer: Molina Healthcare Passport |
$358.41
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.99
|
|
|
SURGICAL CLOSURE TRACHEOSTOM(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 31820
|
| Hospital Charge Code |
410P0063
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$511.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.44
|
| Rate for Payer: Anthem Medicaid |
$227.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$469.15
|
| Rate for Payer: Healthspan PPO |
$508.48
|
| Rate for Payer: Humana Medicaid |
$227.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$422.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.06
|
| Rate for Payer: Molina Healthcare Passport |
$227.51
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$178.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.79
|
|
|
SURGICAL CLOSURE TRACHEOSTOMY
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 31820
|
| Hospital Charge Code |
41000063
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$511.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.44
|
| Rate for Payer: Anthem Medicaid |
$227.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$469.15
|
| Rate for Payer: Healthspan PPO |
$508.48
|
| Rate for Payer: Humana Medicaid |
$227.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$422.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.06
|
| Rate for Payer: Molina Healthcare Passport |
$227.51
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$178.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.79
|
|
|
SURGICAL LOCALIZATION NMD
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 78808
|
| Hospital Charge Code |
34000040
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SURGICAL LOCALIZATION NMD
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 78808
|
| Hospital Charge Code |
34000040
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$499.32 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
SURGICAL OPENING OF STOMACH
|
Professional
|
Both
|
$3,511.00
|
|
|
Service Code
|
HCPCS 43510
|
| Hospital Charge Code |
76101781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.21 |
| Max. Negotiated Rate |
$3,511.00 |
| Rate for Payer: Aetna Commercial |
$1,373.84
|
| Rate for Payer: Anthem Medicaid |
$517.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,511.00
|
| Rate for Payer: Cash Price |
$1,755.50
|
| Rate for Payer: Cash Price |
$1,755.50
|
| Rate for Payer: Cigna Commercial |
$1,247.61
|
| Rate for Payer: Healthspan PPO |
$1,158.58
|
| Rate for Payer: Humana Medicaid |
$517.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,203.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$527.55
|
| Rate for Payer: Molina Healthcare Passport |
$517.21
|
| Rate for Payer: Multiplan PHCS |
$2,106.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,228.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$522.38
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
IP
|
$3,511.00
|
|
|
Service Code
|
HCPCS 43510
|
| Hospital Charge Code |
76101781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.43 |
| Max. Negotiated Rate |
$3,370.56 |
| Rate for Payer: Aetna Commercial |
$2,703.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,738.58
|
| Rate for Payer: Cash Price |
$1,755.50
|
| Rate for Payer: Cigna Commercial |
$2,914.13
|
| Rate for Payer: First Health Commercial |
$3,335.45
|
| Rate for Payer: Humana Commercial |
$2,984.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,089.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,633.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.41
|
| Rate for Payer: PHCS Commercial |
$3,370.56
|
| Rate for Payer: United Healthcare All Payer |
$3,089.68
|
|
|
SURGICAL OPENING OF STOMACH
|
Facility
|
OP
|
$3,511.00
|
|
|
Service Code
|
HCPCS 43510
|
| Hospital Charge Code |
76101781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.43 |
| Max. Negotiated Rate |
$3,370.56 |
| Rate for Payer: Aetna Commercial |
$2,703.47
|
| Rate for Payer: Anthem Medicaid |
$1,207.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,738.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,755.50
|
| Rate for Payer: Cash Price |
$1,755.50
|
| Rate for Payer: Cigna Commercial |
$2,914.13
|
| Rate for Payer: First Health Commercial |
$3,335.45
|
| Rate for Payer: Humana Commercial |
$2,984.35
|
| Rate for Payer: Humana KY Medicaid |
$1,207.43
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,219.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,231.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,089.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,633.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.41
|
| Rate for Payer: PHCS Commercial |
$3,370.56
|
| Rate for Payer: United Healthcare All Payer |
$3,089.68
|
|
|
SURGICAL OPENING OF STOMACH(P
|
Professional
|
Both
|
$2,385.00
|
|
|
Service Code
|
HCPCS 43510
|
| Hospital Charge Code |
761P1781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$517.21 |
| Max. Negotiated Rate |
$2,385.00 |
| Rate for Payer: Aetna Commercial |
$1,373.84
|
| Rate for Payer: Anthem Medicaid |
$517.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,385.00
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cash Price |
$1,192.50
|
| Rate for Payer: Cigna Commercial |
$1,247.61
|
| Rate for Payer: Healthspan PPO |
$1,158.58
|
| Rate for Payer: Humana Medicaid |
$517.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,203.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$527.55
|
| Rate for Payer: Molina Healthcare Passport |
$517.21
|
| Rate for Payer: Multiplan PHCS |
$1,431.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,669.50
|
| Rate for Payer: UHCCP Medicaid |
$834.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$522.38
|
|
