|
US RETROPERITONL URIN BLD LTD
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
|
|
US RETROPERITONL URIN BLD LT(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402P0030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$169.22 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$139.15
|
| Rate for Payer: Healthspan PPO |
$158.56
|
| Rate for Payer: Humana Medicaid |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
|
|
US RETROPERITONL URIN BLD LT(T
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.90
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
|
US RETROPERITONL URIN BLD LT(T
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem Medicaid |
$271.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Humana KY Medicaid |
$271.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$274.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.90
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
|
|
US SFT TIS PELV WALL/BUT/PEN(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402P0047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$134.34 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$134.34
|
| Rate for Payer: Healthspan PPO |
$117.50
|
| Rate for Payer: Humana Medicaid |
$44.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
|
|
US SFT TIS PELV WALL/BUT/PEN(T
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US SFT TIS PELV WALL/BUT/PEN(T
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
US SOFT TISSUE AXILLA
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
US SOFT TISSUE AXILLA
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
US SOFT TISSUE AXILLA
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
US SOFT TISSUE AXILLA(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
US SOFT TISSUE AXILLA(T
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
US SOFT TISSUE AXILLA(T
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
US SOFT TISSUE EXT LIMITED
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
US SOFT TISSUE EXT LIMITED
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$293.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
US SOFT TISSUE EXT LIMITED
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
US SOFT TISSUE EXT LIMITED(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402P0056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$50.74
|
| Rate for Payer: Healthspan PPO |
$33.70
|
| Rate for Payer: Humana Medicaid |
$26.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
|
|
US SOFT TISSUE EXT LIMITED(T
|
Facility
|
IP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
US SOFT TISSUE EXT LIMITED(T
|
Facility
|
OP
|
$763.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$732.48 |
| Rate for Payer: Aetna Commercial |
$587.51
|
| Rate for Payer: Anthem Medicaid |
$262.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$595.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cash Price |
$381.50
|
| Rate for Payer: Cigna Commercial |
$633.29
|
| Rate for Payer: First Health Commercial |
$724.85
|
| Rate for Payer: Humana Commercial |
$648.55
|
| Rate for Payer: Humana KY Medicaid |
$262.40
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$265.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$625.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$563.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$671.44
|
| Rate for Payer: Ohio Health Group HMO |
$572.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.53
|
| Rate for Payer: PHCS Commercial |
$732.48
|
| Rate for Payer: United Healthcare All Payer |
$671.44
|
|
|
US spinal canal and contents
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
40200107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$117.91 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
|
US spinal canal and contents
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
40200107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$907.00 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Anthem Medicaid |
$86.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$907.00
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: Healthspan PPO |
$176.62
|
| Rate for Payer: Humana Medicaid |
$86.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$69.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.65
|
| Rate for Payer: Molina Healthcare Passport |
$86.91
|
| Rate for Payer: Multiplan PHCS |
$544.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$634.90
|
| Rate for Payer: UHCCP Medicaid |
$317.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.78
|
|
|
US spinal canal and contents
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
HCPCS 76800
|
| Hospital Charge Code |
40200107
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$870.72 |
| Rate for Payer: Aetna Commercial |
$698.39
|
| Rate for Payer: Anthem Medicaid |
$311.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$707.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cash Price |
$453.50
|
| Rate for Payer: Cigna Commercial |
$752.81
|
| Rate for Payer: First Health Commercial |
$861.65
|
| Rate for Payer: Humana Commercial |
$770.95
|
| Rate for Payer: Humana KY Medicaid |
$311.92
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$315.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$743.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$669.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$318.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$798.16
|
| Rate for Payer: Ohio Health Group HMO |
$680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$281.17
|
| Rate for Payer: PHCS Commercial |
$870.72
|
| Rate for Payer: United Healthcare All Payer |
$798.16
|
|
