|
TORISEL 1 MG (25MG VIAL)
|
Facility
|
OP
|
$32,705.23
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
25002682
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$31,397.02 |
| Rate for Payer: Aetna Commercial |
$25,183.03
|
| Rate for Payer: Anthem Medicaid |
$11,247.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$30.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,510.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$43.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.84
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cash Price |
$16,352.61
|
| Rate for Payer: Cigna Commercial |
$27,145.34
|
| Rate for Payer: First Health Commercial |
$31,069.97
|
| Rate for Payer: Humana Commercial |
$27,799.45
|
| Rate for Payer: Humana KY Medicaid |
$11,247.33
|
| Rate for Payer: Humana Medicare Advantage |
$30.99
|
| Rate for Payer: Kentucky WC Medicaid |
$11,361.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,818.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,136.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,472.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,780.60
|
| Rate for Payer: Ohio Health Group HMO |
$24,528.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,541.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,251.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,138.62
|
| Rate for Payer: PHCS Commercial |
$31,397.02
|
| Rate for Payer: United Healthcare All Payer |
$28,780.60
|
|
|
TORNUS SUPPORT CATH 2.6FR
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
TORNUS SUPPORT CATH 2.6FR
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
TORP SHEA 1MM SHAFT 7MM LENGTH
|
Facility
|
OP
|
$1,876.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.91 |
| Max. Negotiated Rate |
$1,801.17 |
| Rate for Payer: Aetna Commercial |
$1,444.69
|
| Rate for Payer: Anthem Medicaid |
$645.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Cash Price |
$938.11
|
| Rate for Payer: Cigna Commercial |
$1,557.26
|
| Rate for Payer: First Health Commercial |
$1,782.41
|
| Rate for Payer: Humana Commercial |
$1,594.79
|
| Rate for Payer: Humana KY Medicaid |
$645.23
|
| Rate for Payer: Kentucky WC Medicaid |
$651.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.63
|
| Rate for Payer: PHCS Commercial |
$1,801.17
|
| Rate for Payer: United Healthcare All Payer |
$1,651.07
|
|
|
TORP SHEA 1MM SHAFT 7MM LENGTH
|
Facility
|
IP
|
$1,876.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.91 |
| Max. Negotiated Rate |
$1,801.17 |
| Rate for Payer: Aetna Commercial |
$1,444.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Cash Price |
$938.11
|
| Rate for Payer: Cigna Commercial |
$1,557.26
|
| Rate for Payer: First Health Commercial |
$1,782.41
|
| Rate for Payer: Humana Commercial |
$1,594.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.63
|
| Rate for Payer: PHCS Commercial |
$1,801.17
|
| Rate for Payer: United Healthcare All Payer |
$1,651.07
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
761P1904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.50 |
| Max. Negotiated Rate |
$3,050.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,050.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$945.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.50 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.90
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$610.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$945.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
TOTAL ABD COLECT WOANAST/ILEOS
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
HCPCS 45399
|
| Hospital Charge Code |
76101904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.50 |
| Max. Negotiated Rate |
$3,050.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,050.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Multiplan PHCS |
$1,830.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,135.00
|
| Rate for Payer: UHCCP Medicaid |
$1,067.50
|
|
|
TOTAL AB HYST
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
76102213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,013.03 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,988.33
|
| Rate for Payer: Anthem Medicaid |
$1,013.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,941.47
|
| Rate for Payer: Healthspan PPO |
$1,925.21
|
| Rate for Payer: Humana Medicaid |
$1,013.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,705.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,033.29
|
| Rate for Payer: Molina Healthcare Passport |
$1,013.03
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.16
|
|
|
TOTAL AB HYST
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
76102213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
TOTAL AB HYST
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
76102213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
TOTAL AB HYST(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 58200
|
| Hospital Charge Code |
761P2213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,013.03 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,988.33
|
| Rate for Payer: Anthem Medicaid |
$1,013.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,941.47
|
| Rate for Payer: Healthspan PPO |
$1,925.21
|
| Rate for Payer: Humana Medicaid |
$1,013.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,705.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,033.29
|
| Rate for Payer: Molina Healthcare Passport |
$1,013.03
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.16
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
76102210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
TOTAL HYSTERECTOMY
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
76102210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.52 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Anthem Medicaid |
$695.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,455.58
|
| Rate for Payer: Healthspan PPO |
$1,452.78
|
| Rate for Payer: Humana Medicaid |
$695.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,293.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$709.43
|
| Rate for Payer: Molina Healthcare Passport |
$695.52
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$702.48
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
76102210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
TOTAL HYSTERECTOMY(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
761P2210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.52 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Anthem Medicaid |
$695.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,455.58
|
| Rate for Payer: Healthspan PPO |
$1,452.78
|
| Rate for Payer: Humana Medicaid |
$695.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,293.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$709.43
|
| Rate for Payer: Molina Healthcare Passport |
$695.52
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$702.48
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,373.97 |
| Max. Negotiated Rate |
$4,753.00 |
| Rate for Payer: Aetna Commercial |
$2,325.22
|
| Rate for Payer: Anthem Medicaid |
$1,373.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,753.00
|
| Rate for Payer: Cash Price |
$2,376.50
|
| Rate for Payer: Cash Price |
$2,376.50
|
| Rate for Payer: Cigna Commercial |
$2,507.75
|
| Rate for Payer: Healthspan PPO |
$2,106.15
|
| Rate for Payer: Humana Medicaid |
$1,373.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,936.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,401.45
|
| Rate for Payer: Molina Healthcare Passport |
$1,373.97
|
| Rate for Payer: Multiplan PHCS |
$2,851.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,327.10
|
| Rate for Payer: UHCCP Medicaid |
$1,663.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,387.71
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
OP
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.89 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$3,659.81
|
| Rate for Payer: Anthem Medicaid |
$1,634.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,707.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$2,376.50
|
| Rate for Payer: Cash Price |
$2,376.50
|
| Rate for Payer: Cigna Commercial |
$3,944.99
|
| Rate for Payer: First Health Commercial |
$4,515.35
|
| Rate for Payer: Humana Commercial |
$4,040.05
|
| Rate for Payer: Humana KY Medicaid |
$1,634.56
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,651.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,897.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,507.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,667.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,182.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,564.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.43
|
| Rate for Payer: PHCS Commercial |
$4,562.88
|
| Rate for Payer: United Healthcare All Payer |
$4,182.64
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
IP
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.89 |
| Max. Negotiated Rate |
$4,562.88 |
| Rate for Payer: Aetna Commercial |
$3,659.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,707.34
|
| Rate for Payer: Cash Price |
$2,376.50
|
| Rate for Payer: Cigna Commercial |
$3,944.99
|
| Rate for Payer: First Health Commercial |
$4,515.35
|
| Rate for Payer: Humana Commercial |
$4,040.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,897.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,507.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,182.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,564.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.43
|
| Rate for Payer: PHCS Commercial |
$4,562.88
|
| Rate for Payer: United Healthcare All Payer |
$4,182.64
|
|
|
TOTAL LUNG LAVAGE
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
76101235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
TOTAL LUNG LAVAGE
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
76101235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
TOTAL LUNG LAVAGE
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
76101235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Anthem Medicaid |
$245.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: Healthspan PPO |
$472.86
|
| Rate for Payer: Humana Medicaid |
$245.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$478.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.60
|
| Rate for Payer: Molina Healthcare Passport |
$245.69
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.15
|
|
|
TOTAL LUNG LAVAGE(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
761P1235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Anthem Medicaid |
$245.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: Healthspan PPO |
$472.86
|
| Rate for Payer: Humana Medicaid |
$245.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$478.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.60
|
| Rate for Payer: Molina Healthcare Passport |
$245.69
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.15
|
|
|
TOTAL THYROID LOBECTOMY
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
