|
SUPRANE LIQ DESFLURANE EA1/2HR
|
Facility
|
IP
|
$330.22
|
|
|
Service Code
|
NDC 10019064134
|
| Hospital Charge Code |
25003501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$317.01 |
| Rate for Payer: Aetna Commercial |
$254.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$257.57
|
| Rate for Payer: Cash Price |
$165.11
|
| Rate for Payer: Cigna Commercial |
$274.08
|
| Rate for Payer: First Health Commercial |
$313.71
|
| Rate for Payer: Humana Commercial |
$280.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.59
|
| Rate for Payer: Ohio Health Group HMO |
$247.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$317.01
|
| Rate for Payer: United Healthcare All Payer |
$290.59
|
|
|
SUREGLIDE GUIDEWIRE STR .035
|
Facility
|
IP
|
$796.68
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$764.81 |
| Rate for Payer: Aetna Commercial |
$613.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.41
|
| Rate for Payer: Cash Price |
$398.34
|
| Rate for Payer: Cigna Commercial |
$661.24
|
| Rate for Payer: First Health Commercial |
$756.85
|
| Rate for Payer: Humana Commercial |
$677.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.08
|
| Rate for Payer: Ohio Health Group HMO |
$597.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.71
|
| Rate for Payer: PHCS Commercial |
$764.81
|
| Rate for Payer: United Healthcare All Payer |
$701.08
|
|
|
SUREGLIDE GUIDEWIRE STR .035
|
Facility
|
OP
|
$796.68
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$764.81 |
| Rate for Payer: Aetna Commercial |
$613.44
|
| Rate for Payer: Anthem Medicaid |
$273.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.41
|
| Rate for Payer: Cash Price |
$398.34
|
| Rate for Payer: Cigna Commercial |
$661.24
|
| Rate for Payer: First Health Commercial |
$756.85
|
| Rate for Payer: Humana Commercial |
$677.18
|
| Rate for Payer: Humana KY Medicaid |
$273.98
|
| Rate for Payer: Kentucky WC Medicaid |
$276.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.08
|
| Rate for Payer: Ohio Health Group HMO |
$597.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.71
|
| Rate for Payer: PHCS Commercial |
$764.81
|
| Rate for Payer: United Healthcare All Payer |
$701.08
|
|
|
SURG DX EXAM ANORECTAL
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
76101909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna Commercial |
$157.23
|
| Rate for Payer: Ambetter Exchange |
$100.78
|
| Rate for Payer: Anthem Medicaid |
$77.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.78
|
| 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 |
$131.01
|
| Rate for Payer: UHCCP Medicaid |
$115.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.78
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
76101909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$257.40
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
SURG DX EXAM ANORECTAL
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
76101909
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Anthem Medicaid |
$113.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$257.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$273.90
|
| Rate for Payer: First Health Commercial |
$313.50
|
| Rate for Payer: Humana Commercial |
$280.50
|
| Rate for Payer: Humana KY Medicaid |
$113.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$114.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$243.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$290.40
|
| Rate for Payer: Ohio Health Group HMO |
$247.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.70
|
| Rate for Payer: PHCS Commercial |
$316.80
|
| Rate for Payer: United Healthcare All Payer |
$290.40
|
|
|
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 |
$198.00 |
| Rate for Payer: Aetna Commercial |
$157.23
|
| Rate for Payer: Ambetter Exchange |
$100.78
|
| Rate for Payer: Anthem Medicaid |
$77.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.78
|
| 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 |
$131.01
|
| Rate for Payer: UHCCP Medicaid |
$115.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.78
|
|
|
SURGERY OF BREAST CAPSULE
|
Facility
|
OP
|
$6,353.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,184.80 |
| Max. Negotiated Rate |
$6,098.88 |
| Rate for Payer: Aetna Commercial |
$4,891.81
|
| Rate for Payer: Anthem Medicaid |
$2,184.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,955.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,176.50
|
| Rate for Payer: Cash Price |
$3,176.50
|
| Rate for Payer: Cigna Commercial |
$5,272.99
|
| Rate for Payer: First Health Commercial |
$6,035.35
|
| Rate for Payer: Humana Commercial |
$5,400.05
|
| Rate for Payer: Humana KY Medicaid |
$2,184.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,207.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,209.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,688.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,228.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,590.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,082.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,527.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.57
|
| Rate for Payer: PHCS Commercial |
$6,098.88
|
| Rate for Payer: United Healthcare All Payer |
$5,590.64
|
|
|
SURGERY OF BREAST CAPSULE
|
Facility
|
IP
|
$6,353.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,905.90 |
| Max. Negotiated Rate |
$6,098.88 |
| Rate for Payer: Aetna Commercial |
$4,891.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,955.34
|
| Rate for Payer: Cash Price |
$3,176.50
|
| Rate for Payer: Cigna Commercial |
$5,272.99
|
| Rate for Payer: First Health Commercial |
$6,035.35
|
| Rate for Payer: Humana Commercial |
$5,400.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,209.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,688.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,905.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,590.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,082.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,527.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,383.57
|
| Rate for Payer: PHCS Commercial |
$6,098.88
|
| Rate for Payer: United Healthcare All Payer |
$5,590.64
|
|
|
SURGERY OF BREAST CAPSULE
|
Professional
|
Both
|
$6,353.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
76100321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.12 |
| Max. Negotiated Rate |
$3,811.80 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Ambetter Exchange |
$635.72
|
| Rate for Payer: Anthem Medicaid |
$417.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$635.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$762.86
|
| Rate for Payer: Cash Price |
$3,176.50
|
| Rate for Payer: Cash Price |
$3,176.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$635.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.46
|
| Rate for Payer: Molina Healthcare Passport |
$417.12
|
| Rate for Payer: Multiplan PHCS |
$3,811.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$826.44
|
| Rate for Payer: UHCCP Medicaid |
$2,223.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$635.72
|
|
|
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 |
$980.10 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Ambetter Exchange |
$635.72
|
| Rate for Payer: Anthem Medicaid |
$417.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$635.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$762.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$635.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.72
|
| 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 |
$826.44
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$421.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$635.72
|
|
|
SURGERY OF BREAST CAPSULE(T
|
Facility
|
IP
|
$4,878.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
761T0321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,463.40 |
| Max. Negotiated Rate |
$4,682.88 |
| Rate for Payer: Aetna Commercial |
$3,756.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.84
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna Commercial |
$4,048.74
|
| Rate for Payer: First Health Commercial |
$4,634.10
|
| Rate for Payer: Humana Commercial |
$4,146.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,463.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,243.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.82
|
| Rate for Payer: PHCS Commercial |
$4,682.88
|
| Rate for Payer: United Healthcare All Payer |
$4,292.64
|
|
|
SURGERY OF BREAST CAPSULE(T
|
Facility
|
OP
|
$4,878.00
|
|
|
Service Code
|
HCPCS 19370
|
| Hospital Charge Code |
761T0321
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,677.54 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,756.06
|
| Rate for Payer: Anthem Medicaid |
$1,677.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna Commercial |
$4,048.74
|
| Rate for Payer: First Health Commercial |
$4,634.10
|
| Rate for Payer: Humana Commercial |
$4,146.30
|
| Rate for Payer: Humana KY Medicaid |
$1,677.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,711.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,243.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.82
|
| Rate for Payer: PHCS Commercial |
$4,682.88
|
| Rate for Payer: United Healthcare All Payer |
$4,292.64
|
|
|
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 |
$870.00 |
| Rate for Payer: Aetna Commercial |
$814.39
|
| Rate for Payer: Ambetter Exchange |
$496.90
|
| Rate for Payer: Anthem Medicaid |
$345.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$496.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$496.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$596.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$496.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.90
|
| 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 |
$645.97
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$496.90
|
|
|
SURGERY/SPEECH PROSTHESIS
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 31611
|
| Hospital Charge Code |
41000031
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
SURGERY/SPEECH PROSTHESIS
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 31611
|
| Hospital Charge Code |
41000031
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
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 |
$870.00 |
| Rate for Payer: Aetna Commercial |
$814.39
|
| Rate for Payer: Ambetter Exchange |
$496.90
|
| Rate for Payer: Anthem Medicaid |
$345.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$496.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$496.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$596.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$496.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.90
|
| 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 |
$645.97
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$349.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$496.90
|
|
|
SURGERY TO STOP LEG GROWTH
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 27475
|
| Hospital Charge Code |
76100851
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.00 |
| 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 |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| 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 |
$295.75 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
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: Ambetter Exchange |
$633.70
|
| Rate for Payer: Anthem Medicaid |
$476.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$633.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$633.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$760.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$633.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.70
|
| 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 |
$823.81
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$481.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$633.70
|
|
|
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: Ambetter Exchange |
$633.70
|
| Rate for Payer: Anthem Medicaid |
$476.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$633.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$633.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$760.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$633.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.70
|
| 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 |
$823.81
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$481.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$633.70
|
|
|
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 |
$690.00 |
| Rate for Payer: Aetna Commercial |
$626.29
|
| Rate for Payer: Ambetter Exchange |
$455.15
|
| Rate for Payer: Anthem Medicaid |
$358.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$455.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$455.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$546.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$455.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.15
|
| 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 |
$591.70
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$455.15
|
|
|
SURGICAL ANAL FISTULA
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 46280
|
| Hospital Charge Code |
76101923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.49 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| 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 |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| 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 |
$3,040.69
|
| 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 |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| 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 |
$345.00 |
| 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 |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
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 |
$690.00 |
| Rate for Payer: Aetna Commercial |
$626.29
|
| Rate for Payer: Ambetter Exchange |
$455.15
|
| Rate for Payer: Anthem Medicaid |
$358.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$455.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$455.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$546.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$455.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.15
|
| 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 |
$591.70
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$455.15
|
|
