|
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 |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,988.33
|
| Rate for Payer: Ambetter Exchange |
$1,281.95
|
| Rate for Payer: Anthem Medicaid |
$1,013.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,281.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,281.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,538.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,281.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.95
|
| 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 |
$1,666.54
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,281.95
|
|
|
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 |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,988.33
|
| Rate for Payer: Ambetter Exchange |
$1,281.95
|
| Rate for Payer: Anthem Medicaid |
$1,013.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,281.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,281.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,538.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,281.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.95
|
| 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 |
$1,666.54
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,023.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,281.95
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
76102210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| 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 |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
TOTAL HYSTERECTOMY
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 58150
|
| Hospital Charge Code |
76102210
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| 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 |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| 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 |
$1,500.42 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Ambetter Exchange |
$965.93
|
| Rate for Payer: Anthem Medicaid |
$695.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$965.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$965.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,159.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$965.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.93
|
| 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 |
$1,255.71
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$702.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$965.93
|
|
|
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 |
$1,500.42 |
| Rate for Payer: Aetna Commercial |
$1,500.42
|
| Rate for Payer: Ambetter Exchange |
$965.93
|
| Rate for Payer: Anthem Medicaid |
$695.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$965.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$965.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,159.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$965.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.93
|
| 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 |
$1,255.71
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$702.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$965.93
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
IP
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,425.90 |
| 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 |
$3,802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,279.57
|
| Rate for Payer: PHCS Commercial |
$4,562.88
|
| Rate for Payer: United Healthcare All Payer |
$4,182.64
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Facility
|
OP
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,634.56 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$3,659.81
|
| Rate for Payer: Anthem Medicaid |
$1,634.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,707.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| 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 |
$11,888.68
|
| 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 |
$14,266.42
|
| 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 |
$3,802.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,135.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,279.57
|
| Rate for Payer: PHCS Commercial |
$4,562.88
|
| Rate for Payer: United Healthcare All Payer |
$4,182.64
|
|
|
TOTAL KNEE ARTHROPLASTY
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 27447
|
| Hospital Charge Code |
76100849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,217.83 |
| Max. Negotiated Rate |
$2,851.80 |
| Rate for Payer: Aetna Commercial |
$2,325.22
|
| Rate for Payer: Ambetter Exchange |
$1,217.83
|
| Rate for Payer: Anthem Medicaid |
$1,373.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,217.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,217.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,461.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,217.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.83
|
| 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 |
$1,583.18
|
| Rate for Payer: UHCCP Medicaid |
$1,663.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,387.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,217.83
|
|
|
TOTAL LUNG LAVAGE
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
76101235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| 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 |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| 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 |
$605.64 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Ambetter Exchange |
$314.77
|
| Rate for Payer: Anthem Medicaid |
$245.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.77
|
| 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 |
$409.20
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.77
|
|
|
TOTAL LUNG LAVAGE
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 32997
|
| Hospital Charge Code |
76101235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| 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 |
$223.53
|
| 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 |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
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 |
$605.64 |
| Rate for Payer: Aetna Commercial |
$605.64
|
| Rate for Payer: Ambetter Exchange |
$314.77
|
| Rate for Payer: Anthem Medicaid |
$245.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.77
|
| 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 |
$409.20
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.77
|
|
|
TOTAL THYROID LOBECTOMY
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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: 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 |
$660.00
|
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TOTAL THYROID LOBECTOMY
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.51 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,122.99
|
| Rate for Payer: Ambetter Exchange |
$671.23
|
| Rate for Payer: Anthem Medicaid |
$557.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$671.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$671.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$805.48
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,055.85
|
| Rate for Payer: Healthspan PPO |
$947.04
|
| Rate for Payer: Humana Medicaid |
$557.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$988.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$671.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.66
|
| Rate for Payer: Molina Healthcare Passport |
$557.51
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$872.60
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$671.23
|
|
|
TOTAL THYROID LOBECTOMY
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
76102273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| 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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TOTAL THYROID LOBECTOMY(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 60220
|
| Hospital Charge Code |
761P2273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.51 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,122.99
|
| Rate for Payer: Ambetter Exchange |
$671.23
|
| Rate for Payer: Anthem Medicaid |
$557.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$671.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$671.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$805.48
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,055.85
|
| Rate for Payer: Healthspan PPO |
$947.04
|
| Rate for Payer: Humana Medicaid |
$557.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$988.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$671.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.66
|
| Rate for Payer: Molina Healthcare Passport |
$557.51
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$872.60
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$671.23
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 60225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.01 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna Commercial |
$2,245.58
|
| Rate for Payer: Ambetter Exchange |
$1,390.22
|
| Rate for Payer: Anthem Medicaid |
$1,306.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,390.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,390.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,668.26
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,425.81
|
| Rate for Payer: Healthspan PPO |
$2,034.00
|
| Rate for Payer: Humana Medicaid |
$1,306.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,863.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,390.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,332.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,306.01
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,807.29
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,319.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,390.22
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
76100784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,260.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem Medicaid |
$1,444.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Humana KY Medicaid |
$1,444.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,898.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
TOTHIPARTH ACTB WWOAGRFTALGRFT
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 27137
|
| Hospital Charge Code |
761P0784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.01 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna Commercial |
$2,245.58
|
| Rate for Payer: Ambetter Exchange |
$1,390.22
|
| Rate for Payer: Anthem Medicaid |
$1,306.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,390.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,390.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,668.26
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,425.81
|
| Rate for Payer: Healthspan PPO |
$2,034.00
|
| Rate for Payer: Humana Medicaid |
$1,306.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,863.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,390.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,332.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,306.01
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,807.29
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,319.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,390.22
|
|
|
TOT HIPARTH FEM WWO ALGRFT
|
Facility
|
IP
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
76100785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,305.00 |
| Max. Negotiated Rate |
$4,176.00 |
| Rate for Payer: Aetna Commercial |
$3,349.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$3,610.50
|
| Rate for Payer: First Health Commercial |
$4,132.50
|
| Rate for Payer: Humana Commercial |
$3,697.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,210.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,784.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,001.50
|
| Rate for Payer: PHCS Commercial |
$4,176.00
|
| Rate for Payer: United Healthcare All Payer |
$3,828.00
|
|
|
TOT HIPARTH FEM WWO ALGRFT
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 27138
|
| Hospital Charge Code |
76100785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,316.66 |
| Max. Negotiated Rate |
$2,610.00 |
| Rate for Payer: Aetna Commercial |
$2,338.41
|
| Rate for Payer: Ambetter Exchange |
$1,444.27
|
| Rate for Payer: Anthem Medicaid |
$1,316.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,444.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,444.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,733.12
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cash Price |
$2,175.00
|
| Rate for Payer: Cigna Commercial |
$2,524.82
|
| Rate for Payer: Healthspan PPO |
$2,118.10
|
| Rate for Payer: Humana Medicaid |
$1,316.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,939.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,444.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,444.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,342.99
|
| Rate for Payer: Molina Healthcare Passport |
$1,316.66
|
| Rate for Payer: Multiplan PHCS |
$2,610.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,877.55
|
| Rate for Payer: UHCCP Medicaid |
$1,522.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,329.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,444.27
|
|
