|
TX CONTOUR DEFECTS >10.0 CC
|
Professional
|
Both
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$4,806.68 |
| Rate for Payer: Aetna Commercial |
$171.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.79
|
| Rate for Payer: Anthem Medicaid |
$88.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,806.68
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$237.35
|
| Rate for Payer: Healthspan PPO |
$184.36
|
| Rate for Payer: Humana Medicaid |
$88.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.66
|
| Rate for Payer: Molina Healthcare Passport |
$88.88
|
| Rate for Payer: Multiplan PHCS |
$2,884.01
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,364.68
|
| Rate for Payer: UHCCP Medicaid |
$96.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.77
|
|
|
TX CONTOUR DEFECTS >10.0 CC(P
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761P0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Aetna Commercial |
$171.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.79
|
| Rate for Payer: Anthem Medicaid |
$88.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$237.35
|
| Rate for Payer: Healthspan PPO |
$184.36
|
| Rate for Payer: Humana Medicaid |
$88.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.66
|
| Rate for Payer: Molina Healthcare Passport |
$88.88
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$96.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.77
|
|
|
TX CONTOUR DEFECTS >10.0 CC(T
|
Facility
|
OP
|
$4,376.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761T0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.11 |
| Max. Negotiated Rate |
$4,201.61 |
| Rate for Payer: Aetna Commercial |
$3,370.04
|
| Rate for Payer: Anthem Medicaid |
$1,505.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cigna Commercial |
$3,632.64
|
| Rate for Payer: First Health Commercial |
$4,157.85
|
| Rate for Payer: Humana Commercial |
$3,720.18
|
| Rate for Payer: Humana KY Medicaid |
$1,505.14
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.77
|
| Rate for Payer: PHCS Commercial |
$4,201.61
|
| Rate for Payer: United Healthcare All Payer |
$3,851.48
|
|
|
TX CONTOUR DEFECTS >10.0 CC(T
|
Facility
|
IP
|
$4,376.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761T0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$568.97 |
| Max. Negotiated Rate |
$4,201.61 |
| Rate for Payer: Aetna Commercial |
$3,370.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.81
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cigna Commercial |
$3,632.64
|
| Rate for Payer: First Health Commercial |
$4,157.85
|
| Rate for Payer: Humana Commercial |
$3,720.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.77
|
| Rate for Payer: PHCS Commercial |
$4,201.61
|
| Rate for Payer: United Healthcare All Payer |
$3,851.48
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem Medicaid |
$365.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Humana KY Medicaid |
$365.22
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$1,062.00 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,062.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$199.73
|
| Rate for Payer: Healthspan PPO |
$159.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.01
|
| Rate for Payer: Multiplan PHCS |
$637.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$743.40
|
| Rate for Payer: UHCCP Medicaid |
$74.91
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.22
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
TX CONTOUR DEFECTS 5.1-10CC(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
761P0111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$199.73
|
| Rate for Payer: Healthspan PPO |
$159.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.01
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$74.91
|
|
|
TX CONTOUR DEFECTS 5.1-10CC(T
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
761T0111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$683.52 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$590.96
|
| Rate for Payer: First Health Commercial |
$676.40
|
| Rate for Payer: Humana Commercial |
$605.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
| Rate for Payer: Ohio Health Group HMO |
$534.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.72
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
TX CONTOUR DEFECTS 5.1-10CC(T
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
761T0111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem Medicaid |
$244.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$590.96
|
| Rate for Payer: First Health Commercial |
$676.40
|
| Rate for Payer: Humana Commercial |
$605.20
|
| Rate for Payer: Humana KY Medicaid |
$244.86
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$247.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
| Rate for Payer: Ohio Health Group HMO |
$534.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.72
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
TX HUM SHFTFX WIMEDIMP WWOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24516
|
| Hospital Charge Code |
76100535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,281.74
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,401.54
|
| Rate for Payer: Healthspan PPO |
$1,160.99
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,072.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
|
|
TX HUM SHFTFX WIMEDIMP WWOCERC
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24516
|
| Hospital Charge Code |
76100535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
TX HUM SHFTFX WIMEDIMP WWOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24516
|
| Hospital Charge Code |
761P0535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,281.74
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,401.54
|
| Rate for Payer: Healthspan PPO |
$1,160.99
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,072.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
|
|
TX HUM SHFTFX WIMEDIMP WWOCERC
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24516
|
| Hospital Charge Code |
76100535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
TX INCOMP ABORT ANY TRIM SURG
|
Facility
|
IP
|
$6,189.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
72000027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$804.57 |
| Max. Negotiated Rate |
$5,941.44 |
| Rate for Payer: Aetna Commercial |
$4,765.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,827.42
|
| Rate for Payer: Cash Price |
$3,094.50
|
| Rate for Payer: Cigna Commercial |
$5,136.87
|
| Rate for Payer: First Health Commercial |
$5,879.55
|
| Rate for Payer: Humana Commercial |
$5,260.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,074.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,567.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,856.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,446.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,641.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,237.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,918.59
|
| Rate for Payer: PHCS Commercial |
$5,941.44
|
| Rate for Payer: United Healthcare All Payer |
$5,446.32
|
|
|
TX INCOMP ABORT ANY TRIM SURG
|
Facility
|
OP
|
$6,189.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
72000027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$804.57 |
| Max. Negotiated Rate |
$5,941.44 |
| Rate for Payer: Aetna Commercial |
$4,765.53
|
| Rate for Payer: Anthem Medicaid |
$2,128.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,827.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,094.50
|
| Rate for Payer: Cash Price |
$3,094.50
|
| Rate for Payer: Cigna Commercial |
$5,136.87
|
| Rate for Payer: First Health Commercial |
$5,879.55
|
| Rate for Payer: Humana Commercial |
$5,260.65
|
| Rate for Payer: Humana KY Medicaid |
$2,128.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,150.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,074.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,567.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,171.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,446.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,641.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,237.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,918.59
|
| Rate for Payer: PHCS Commercial |
$5,941.44
|
| Rate for Payer: United Healthcare All Payer |
$5,446.32
|
|
|
TX INCOMP ABORT ANY TRIM SURG
|
Professional
|
Both
|
$6,189.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
72000027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$6,189.00 |
| Rate for Payer: Aetna Commercial |
$474.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.93
|
| Rate for Payer: Anthem Medicaid |
$206.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,189.00
|
| Rate for Payer: Cash Price |
$3,094.50
|
| Rate for Payer: Cash Price |
$3,094.50
|
| Rate for Payer: Cigna Commercial |
$435.44
|
| Rate for Payer: Healthspan PPO |
$367.04
|
| Rate for Payer: Humana Medicaid |
$206.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.63
|
| Rate for Payer: Molina Healthcare Passport |
$206.50
|
| Rate for Payer: Multiplan PHCS |
$3,713.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,332.30
|
| Rate for Payer: UHCCP Medicaid |
$178.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.56
|
|
|
TX INCOMP ABORT ANY TRIM SUR(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
720P0027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$474.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.93
|
| Rate for Payer: Anthem Medicaid |
$206.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$435.44
|
| Rate for Payer: Healthspan PPO |
$367.04
|
| Rate for Payer: Humana Medicaid |
$206.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.63
|
| Rate for Payer: Molina Healthcare Passport |
$206.50
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$178.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.56
|
|
|
TX INCOMP ABORT ANY TRIM SUR(T
|
Facility
|
IP
|
$5,314.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
720T0027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$690.82 |
| Max. Negotiated Rate |
$5,101.44 |
| Rate for Payer: Aetna Commercial |
$4,091.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,144.92
|
| Rate for Payer: Cash Price |
$2,657.00
|
| Rate for Payer: Cigna Commercial |
$4,410.62
|
| Rate for Payer: First Health Commercial |
$5,048.30
|
| Rate for Payer: Humana Commercial |
$4,516.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,357.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,921.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,676.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,985.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,062.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.34
|
| Rate for Payer: PHCS Commercial |
$5,101.44
|
| Rate for Payer: United Healthcare All Payer |
$4,676.32
|
|
|
TX INCOMP ABORT ANY TRIM SUR(T
|
Facility
|
OP
|
$5,314.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
720T0027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$690.82 |
| Max. Negotiated Rate |
$5,101.44 |
| Rate for Payer: Aetna Commercial |
$4,091.78
|
| Rate for Payer: Anthem Medicaid |
$1,827.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,144.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,657.00
|
| Rate for Payer: Cash Price |
$2,657.00
|
| Rate for Payer: Cigna Commercial |
$4,410.62
|
| Rate for Payer: First Health Commercial |
$5,048.30
|
| Rate for Payer: Humana Commercial |
$4,516.90
|
| Rate for Payer: Humana KY Medicaid |
$1,827.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,357.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,921.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,864.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,676.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,985.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,062.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$690.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,647.34
|
| Rate for Payer: PHCS Commercial |
$5,101.44
|
| Rate for Payer: United Healthcare All Payer |
$4,676.32
|
|
|
TX INT/PR/SUBTRCHN FEM FX IMD
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 27245
|
| Hospital Charge Code |
76100795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.17 |
| Max. Negotiated Rate |
$3,275.00 |
| Rate for Payer: Aetna Commercial |
$1,910.11
|
| Rate for Payer: Anthem Medicaid |
$1,050.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,275.00
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,314.42
|
| Rate for Payer: Healthspan PPO |
$1,730.15
|
| Rate for Payer: Humana Medicaid |
$1,050.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,555.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,071.17
|
| Rate for Payer: Molina Healthcare Passport |
$1,050.17
|
| Rate for Payer: Multiplan PHCS |
$1,965.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,292.50
|
| Rate for Payer: UHCCP Medicaid |
$1,146.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,060.67
|
|
|
TX INT/PR/SUBTRCHN FEM FX IMD
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS 27245
|
| Hospital Charge Code |
76100795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.25
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
TX INT/PR/SUBTRCHN FEM FX IMD
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 27245
|
| Hospital Charge Code |
761P0795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.17 |
| Max. Negotiated Rate |
$3,275.00 |
| Rate for Payer: Aetna Commercial |
$1,910.11
|
| Rate for Payer: Anthem Medicaid |
$1,050.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,275.00
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,314.42
|
| Rate for Payer: Healthspan PPO |
$1,730.15
|
| Rate for Payer: Humana Medicaid |
$1,050.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,555.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,071.17
|
| Rate for Payer: Molina Healthcare Passport |
$1,050.17
|
| Rate for Payer: Multiplan PHCS |
$1,965.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,292.50
|
| Rate for Payer: UHCCP Medicaid |
$1,146.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,060.67
|
|
|
TX INT/PR/SUBTRCHN FEM FX IMD
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS 27245
|
| Hospital Charge Code |
76100795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.75 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.25
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX
|
Facility
|
OP
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
76100794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$2,457.60 |
| Rate for Payer: Aetna Commercial |
$1,971.20
|
| Rate for Payer: Anthem Medicaid |
$880.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$2,124.80
|
| Rate for Payer: First Health Commercial |
$2,432.00
|
| Rate for Payer: Humana Commercial |
$2,176.00
|
| Rate for Payer: Humana KY Medicaid |
$880.38
|
| Rate for Payer: Kentucky WC Medicaid |
$889.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,099.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,889.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$768.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$898.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,252.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.60
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
