|
VAG HYST W/ANTERIOR REPAIR
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/ANTERIOR REPAIR
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
76102216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/ANTERIOR REPAIR(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58267
|
| Hospital Charge Code |
761P2216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$778.08 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,605.99
|
| Rate for Payer: Anthem Medicaid |
$778.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,568.22
|
| Rate for Payer: Healthspan PPO |
$1,555.01
|
| Rate for Payer: Humana Medicaid |
$778.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,375.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$793.64
|
| Rate for Payer: Molina Healthcare Passport |
$778.08
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$785.86
|
|
|
VAG HYST W/BSO
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
76102215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/BSO
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
76102215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.38 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,402.11
|
| Rate for Payer: Anthem Medicaid |
$685.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,367.84
|
| Rate for Payer: Healthspan PPO |
$1,357.60
|
| Rate for Payer: Humana Medicaid |
$685.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,200.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$699.09
|
| Rate for Payer: Molina Healthcare Passport |
$685.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$692.23
|
|
|
VAG HYST W/BSO
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
76102215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/BSO(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58262
|
| Hospital Charge Code |
761P2215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.38 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,402.11
|
| Rate for Payer: Anthem Medicaid |
$685.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,367.84
|
| Rate for Payer: Healthspan PPO |
$1,357.60
|
| Rate for Payer: Humana Medicaid |
$685.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,200.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$699.09
|
| Rate for Payer: Molina Healthcare Passport |
$685.38
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$692.23
|
|
|
VAG HYST W/ENTEROCEL REPAIR
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58270
|
| Hospital Charge Code |
76102217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VAG HYST W/ENTEROCEL REPAIR
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58270
|
| Hospital Charge Code |
76102217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
VAG HYST W/ENTEROCEL REPAIR
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58270
|
| Hospital Charge Code |
76102217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.47 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,344.96
|
| Rate for Payer: Anthem Medicaid |
$700.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,312.93
|
| Rate for Payer: Healthspan PPO |
$1,302.26
|
| Rate for Payer: Humana Medicaid |
$700.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,148.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$714.48
|
| Rate for Payer: Molina Healthcare Passport |
$700.47
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$707.47
|
|
|
VAG HYST W/ENTEROCEL REPAIR(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58270
|
| Hospital Charge Code |
761P2217
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.47 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,344.96
|
| Rate for Payer: Anthem Medicaid |
$700.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,312.93
|
| Rate for Payer: Healthspan PPO |
$1,302.26
|
| Rate for Payer: Humana Medicaid |
$700.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,148.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$714.48
|
| Rate for Payer: Molina Healthcare Passport |
$700.47
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$707.47
|
|
|
VAG HYST W/POSTERIOR REPAIR
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58280
|
| Hospital Charge Code |
76102218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/POSTERIOR REPAIR
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58280
|
| Hospital Charge Code |
76102218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
VAG HYST W/POSTERIOR REPAIR
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58280
|
| Hospital Charge Code |
76102218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$758.60 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,601.59
|
| Rate for Payer: Anthem Medicaid |
$758.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,561.90
|
| Rate for Payer: Healthspan PPO |
$1,550.74
|
| Rate for Payer: Humana Medicaid |
$758.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,370.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.77
|
| Rate for Payer: Molina Healthcare Passport |
$758.60
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$766.19
|
|
|
VAG HYST W/POSTERIOR REPAIR(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58280
|
| Hospital Charge Code |
761P2218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$758.60 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,601.59
|
| Rate for Payer: Anthem Medicaid |
$758.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,561.90
|
| Rate for Payer: Healthspan PPO |
$1,550.74
|
| Rate for Payer: Humana Medicaid |
$758.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,370.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$773.77
|
| Rate for Payer: Molina Healthcare Passport |
$758.60
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$766.19
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$19,607.36
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$13,305.00 |
| Max. Negotiated Rate |
$19,607.36 |
| Rate for Payer: Anthem Medicaid |
$13,305.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,005.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,607.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,907.10
|
| Rate for Payer: Humana KY Medicaid |
$13,305.00
|
| Rate for Payer: Humana Medicare Advantage |
$14,005.26
|
| Rate for Payer: Kentucky WC Medicaid |
$13,438.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,806.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,571.10
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$10,378.65
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$7,042.65 |
| Max. Negotiated Rate |
$10,378.65 |
| Rate for Payer: Anthem Medicaid |
$7,042.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,413.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,378.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,007.98
|
| Rate for Payer: Humana KY Medicaid |
$7,042.65
|
| Rate for Payer: Humana Medicare Advantage |
$7,413.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,113.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,895.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,183.51
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$14,249.59
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$14,249.59 |
| Rate for Payer: Anthem Medicaid |
$9,669.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,178.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,249.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,740.68
|
| Rate for Payer: Humana KY Medicaid |
$9,669.37
|
| Rate for Payer: Humana Medicare Advantage |
$10,178.28
|
| Rate for Payer: Kentucky WC Medicaid |
$9,766.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,862.75
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$8,735.06
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$8,735.06 |
| Rate for Payer: Anthem Medicaid |
$5,927.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,239.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,735.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,423.10
|
| Rate for Payer: Humana KY Medicaid |
$5,927.36
|
| Rate for Payer: Humana Medicare Advantage |
$6,239.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,986.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.91
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$11,794.12
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$11,794.12 |
| Rate for Payer: Anthem Medicaid |
$8,003.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,424.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,794.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,372.90
|
| Rate for Payer: Humana KY Medicaid |
$8,003.15
|
| Rate for Payer: Humana Medicare Advantage |
$8,424.37
|
| Rate for Payer: Kentucky WC Medicaid |
$8,083.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,163.21
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$7,654.14
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,193.88 |
| Max. Negotiated Rate |
$7,654.14 |
| Rate for Payer: Anthem Medicaid |
$5,193.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,467.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,654.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,380.77
|
| Rate for Payer: Humana KY Medicaid |
$5,193.88
|
| Rate for Payer: Humana Medicare Advantage |
$5,467.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5,245.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,297.76
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$11,650.27
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$11,650.27 |
| Rate for Payer: Anthem Medicaid |
$7,905.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,321.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,650.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,234.19
|
| Rate for Payer: Humana KY Medicaid |
$7,905.54
|
| Rate for Payer: Humana Medicare Advantage |
$8,321.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7,984.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,063.65
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$16,592.73
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$16,592.73 |
| Rate for Payer: Anthem Medicaid |
$11,259.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,851.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,592.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,000.13
|
| Rate for Payer: Humana KY Medicaid |
$11,259.35
|
| Rate for Payer: Humana Medicare Advantage |
$11,851.95
|
| Rate for Payer: Kentucky WC Medicaid |
$11,371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,484.54
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$9,769.19
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,380.00 |
| Max. Negotiated Rate |
$9,769.19 |
| Rate for Payer: Anthem Medicaid |
$6,629.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,977.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,769.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,420.29
|
| Rate for Payer: Humana KY Medicaid |
$6,629.09
|
| Rate for Payer: Humana Medicare Advantage |
$6,977.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6,695.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,380.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,761.67
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 58290
|
| Hospital Charge Code |
76102219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$6,534.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,841.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
