|
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 |
$213.60 |
| 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 |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| 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 |
761P0535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$1,401.54 |
| Rate for Payer: Aetna Commercial |
$1,281.74
|
| Rate for Payer: Ambetter Exchange |
$817.66
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$817.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$817.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$981.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$817.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$817.66
|
| 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 |
$1,062.96
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$817.66
|
|
|
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 |
$722.19 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$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 |
$11,888.68
|
| 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 |
$14,266.42
|
| 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 |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| 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 |
76100535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$1,401.54 |
| Rate for Payer: Aetna Commercial |
$1,281.74
|
| Rate for Payer: Ambetter Exchange |
$817.66
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$817.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$817.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$981.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$817.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$817.66
|
| 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 |
$1,062.96
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$817.66
|
|
|
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 |
$630.00 |
| 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 |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
TX INCOMP ABORT ANY TRIM SURG
|
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 |
$3,713.40 |
| Rate for Payer: Aetna Commercial |
$474.77
|
| Rate for Payer: Ambetter Exchange |
$293.00
|
| 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 Individual/Medicaid |
$293.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$351.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$293.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.00
|
| 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 |
$380.90
|
| Rate for Payer: UHCCP Medicaid |
$178.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.00
|
|
|
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 |
$2,128.40 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,827.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,951.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,384.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,270.41
|
| 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
|
IP
|
$6,189.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
72000027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,856.70 |
| 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 |
$4,951.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,384.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,270.41
|
| Rate for Payer: PHCS Commercial |
$5,941.44
|
| Rate for Payer: United Healthcare All Payer |
$5,446.32
|
|
|
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 |
$525.00 |
| Rate for Payer: Aetna Commercial |
$474.77
|
| Rate for Payer: Ambetter Exchange |
$293.00
|
| 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 Individual/Medicaid |
$293.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$351.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$293.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.00
|
| 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 |
$380.90
|
| Rate for Payer: UHCCP Medicaid |
$178.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.00
|
|
|
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 |
$1,827.48 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,144.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,623.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,666.66
|
| 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
|
IP
|
$5,314.00
|
|
|
Service Code
|
HCPCS 59812
|
| Hospital Charge Code |
720T0027
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,594.20 |
| 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 |
$4,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,623.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,666.66
|
| 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
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS 27245
|
| Hospital Charge Code |
76100795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.50 |
| 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 |
$1,137.73
|
| 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 |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| 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 |
76100795
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.17 |
| Max. Negotiated Rate |
$2,314.42 |
| Rate for Payer: Aetna Commercial |
$1,910.11
|
| Rate for Payer: Ambetter Exchange |
$1,164.45
|
| Rate for Payer: Anthem Medicaid |
$1,050.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,164.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,164.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,397.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,164.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.45
|
| 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 |
$1,513.79
|
| Rate for Payer: UHCCP Medicaid |
$1,146.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,060.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,164.45
|
|
|
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 |
$982.50 |
| 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 |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| 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 |
$2,314.42 |
| Rate for Payer: Aetna Commercial |
$1,910.11
|
| Rate for Payer: Ambetter Exchange |
$1,164.45
|
| Rate for Payer: Anthem Medicaid |
$1,050.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,164.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,164.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,397.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,164.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.45
|
| 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 |
$1,513.79
|
| Rate for Payer: UHCCP Medicaid |
$1,146.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,060.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,164.45
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX
|
Facility
|
IP
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
76100794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.00 |
| Max. Negotiated Rate |
$2,457.60 |
| Rate for Payer: Aetna Commercial |
$1,971.20
|
| 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: 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: 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 |
$2,048.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,227.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.40
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
|
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 |
$768.00 |
| 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 |
$2,048.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,227.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,766.40
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
76100794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.00 |
| Max. Negotiated Rate |
$1,883.32 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Ambetter Exchange |
$1,166.00
|
| Rate for Payer: Anthem Medicaid |
$921.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,166.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,166.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,883.32
|
| Rate for Payer: Healthspan PPO |
$1,651.29
|
| Rate for Payer: Humana Medicaid |
$921.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,166.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,166.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$940.38
|
| Rate for Payer: Molina Healthcare Passport |
$921.94
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,515.80
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$931.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,166.00
|
|
|
TX INT/PR/SUBTRCHNTRC FEM FX(P
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27244
|
| Hospital Charge Code |
761P0794
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.00 |
| Max. Negotiated Rate |
$1,883.32 |
| Rate for Payer: Aetna Commercial |
$1,823.04
|
| Rate for Payer: Ambetter Exchange |
$1,166.00
|
| Rate for Payer: Anthem Medicaid |
$921.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,166.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,166.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,883.32
|
| Rate for Payer: Healthspan PPO |
$1,651.29
|
| Rate for Payer: Humana Medicaid |
$921.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,166.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,166.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$940.38
|
| Rate for Payer: Molina Healthcare Passport |
$921.94
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,515.80
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$931.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,166.00
|
|
|
TX MISSED ABORT 1ST TRIMESTE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720P0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$552.49
|
| Rate for Payer: Ambetter Exchange |
$365.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.62
|
| Rate for Payer: Anthem Medicaid |
$228.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.47
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$510.03
|
| Rate for Payer: Healthspan PPO |
$428.33
|
| Rate for Payer: Humana Medicaid |
$228.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.31
|
| Rate for Payer: Molina Healthcare Passport |
$228.74
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$475.01
|
| Rate for Payer: UHCCP Medicaid |
$210.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.39
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Professional
|
Both
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$200.62 |
| Max. Negotiated Rate |
$3,641.40 |
| Rate for Payer: Aetna Commercial |
$552.49
|
| Rate for Payer: Ambetter Exchange |
$365.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.62
|
| Rate for Payer: Anthem Medicaid |
$228.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.47
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$510.03
|
| Rate for Payer: Healthspan PPO |
$428.33
|
| Rate for Payer: Humana Medicaid |
$228.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$466.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.31
|
| Rate for Payer: Molina Healthcare Passport |
$228.74
|
| Rate for Payer: Multiplan PHCS |
$3,641.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$475.01
|
| Rate for Payer: UHCCP Medicaid |
$210.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.39
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Facility
|
IP
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,820.70 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$4,673.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,733.82
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$5,037.27
|
| Rate for Payer: First Health Commercial |
$5,765.55
|
| Rate for Payer: Humana Commercial |
$5,158.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,976.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,478.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,820.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,340.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,551.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,280.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.61
|
| Rate for Payer: PHCS Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare All Payer |
$5,340.72
|
|
|
TX MISSED ABORT 1ST TRIMESTER
|
Facility
|
OP
|
$6,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
72000028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,087.13 |
| Max. Negotiated Rate |
$5,826.24 |
| Rate for Payer: Aetna Commercial |
$4,673.13
|
| Rate for Payer: Anthem Medicaid |
$2,087.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,733.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cash Price |
$3,034.50
|
| Rate for Payer: Cigna Commercial |
$5,037.27
|
| Rate for Payer: First Health Commercial |
$5,765.55
|
| Rate for Payer: Humana Commercial |
$5,158.65
|
| Rate for Payer: Humana KY Medicaid |
$2,087.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,108.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,976.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,478.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,129.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,340.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,551.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,855.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,280.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,187.61
|
| Rate for Payer: PHCS Commercial |
$5,826.24
|
| Rate for Payer: United Healthcare All Payer |
$5,340.72
|
|
|
TX MISSED ABORT 1ST TRIMESTE(T
|
Facility
|
OP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720T0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,743.23 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem Medicaid |
$1,743.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Humana KY Medicaid |
$1,743.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
|
TX MISSED ABORT 1ST TRIMESTE(T
|
Facility
|
IP
|
$5,069.00
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
720T0028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,520.70 |
| Max. Negotiated Rate |
$4,866.24 |
| Rate for Payer: Aetna Commercial |
$3,903.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,953.82
|
| Rate for Payer: Cash Price |
$2,534.50
|
| Rate for Payer: Cigna Commercial |
$4,207.27
|
| Rate for Payer: First Health Commercial |
$4,815.55
|
| Rate for Payer: Humana Commercial |
$4,308.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,156.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,740.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,520.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,460.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,801.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,055.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,497.61
|
| Rate for Payer: PHCS Commercial |
$4,866.24
|
| Rate for Payer: United Healthcare All Payer |
$4,460.72
|
|
