|
US RETROPERITONL URIN BLD LTD
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem Medicaid |
$332.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Humana KY Medicaid |
$332.55
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$335.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
US RETROPERITONL URIN BLD LTD
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$580.20 |
| Rate for Payer: Aetna Commercial |
$169.22
|
| Rate for Payer: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cash Price |
$483.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.90
|
| Rate for Payer: Molina Healthcare Passport |
$63.63
|
| Rate for Payer: Multiplan PHCS |
$580.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$338.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONL URIN BLD LTD
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
40200030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.10 |
| Max. Negotiated Rate |
$928.32 |
| Rate for Payer: Aetna Commercial |
$744.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$754.26
|
| Rate for Payer: Cash Price |
$483.50
|
| Rate for Payer: Cigna Commercial |
$802.61
|
| Rate for Payer: First Health Commercial |
$918.65
|
| Rate for Payer: Humana Commercial |
$821.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$713.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.96
|
| Rate for Payer: Ohio Health Group HMO |
$725.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.23
|
| Rate for Payer: PHCS Commercial |
$928.32
|
| Rate for Payer: United Healthcare All Payer |
$850.96
|
|
|
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: Ambetter Exchange |
$55.46
|
| Rate for Payer: Anthem Medicaid |
$63.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$55.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$66.55
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$55.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.46
|
| 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 |
$72.10
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$55.46
|
|
|
US RETROPERITONL URIN BLD LT(T
|
Facility
|
OP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem Medicaid |
$289.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Humana KY Medicaid |
$289.56
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$292.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US RETROPERITONL URIN BLD LT(T
|
Facility
|
IP
|
$842.00
|
|
|
Service Code
|
HCPCS 76775
|
| Hospital Charge Code |
402T0030
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$808.32 |
| Rate for Payer: Aetna Commercial |
$648.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$656.76
|
| Rate for Payer: Cash Price |
$421.00
|
| Rate for Payer: Cigna Commercial |
$698.86
|
| Rate for Payer: First Health Commercial |
$799.90
|
| Rate for Payer: Humana Commercial |
$715.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$690.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$740.96
|
| Rate for Payer: Ohio Health Group HMO |
$631.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.98
|
| Rate for Payer: PHCS Commercial |
$808.32
|
| Rate for Payer: United Healthcare All Payer |
$740.96
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.86
|
| Rate for Payer: Molina Healthcare Passport |
$44.96
|
| Rate for Payer: Multiplan PHCS |
$538.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$313.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Facility
|
IP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$269.10 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
US SFT TIS PELV WALL/BUT/PEN
|
Facility
|
OP
|
$897.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
40200047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$690.69
|
| Rate for Payer: Anthem Medicaid |
$308.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$699.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cash Price |
$448.50
|
| Rate for Payer: Cigna Commercial |
$744.51
|
| Rate for Payer: First Health Commercial |
$852.15
|
| Rate for Payer: Humana Commercial |
$762.45
|
| Rate for Payer: Humana KY Medicaid |
$308.48
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$311.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$735.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$661.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$314.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$789.36
|
| Rate for Payer: Ohio Health Group HMO |
$672.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.93
|
| Rate for Payer: PHCS Commercial |
$861.12
|
| Rate for Payer: United Healthcare All Payer |
$789.36
|
|
|
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: Ambetter Exchange |
$45.76
|
| Rate for Payer: Anthem Medicaid |
$44.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.91
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$45.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.76
|
| 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 |
$59.49
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.76
|
|
|
US SFT TIS PELV WALL/BUT/PEN(T
|
Facility
|
IP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US SFT TIS PELV WALL/BUT/PEN(T
|
Facility
|
OP
|
$772.00
|
|
|
Service Code
|
HCPCS 76857
|
| Hospital Charge Code |
402T0047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$741.12 |
| Rate for Payer: Aetna Commercial |
$594.44
|
| Rate for Payer: Anthem Medicaid |
$265.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cash Price |
$386.00
|
| Rate for Payer: Cigna Commercial |
$640.76
|
| Rate for Payer: First Health Commercial |
$733.40
|
| Rate for Payer: Humana Commercial |
$656.20
|
| Rate for Payer: Humana KY Medicaid |
$265.49
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$268.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$679.36
|
| Rate for Payer: Ohio Health Group HMO |
$579.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.68
|
| Rate for Payer: PHCS Commercial |
$741.12
|
| Rate for Payer: United Healthcare All Payer |
$679.36
|
|
|
US SOFT TISSUE AXILLA
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
US SOFT TISSUE AXILLA
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
US SOFT TISSUE AXILLA
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
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 |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| 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 |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
US SOFT TISSUE AXILLA(T
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
US SOFT TISSUE AXILLA(T
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0059
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
US SOFT TISSUE EXT LIMITED
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
US SOFT TISSUE EXT LIMITED
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Passport |
$26.41
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$310.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
US SOFT TISSUE EXT LIMITED
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
40200056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.40 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$772.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.72
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
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 |
$76.78 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Ambetter Exchange |
$59.06
|
| Rate for Payer: Anthem Medicaid |
$26.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$59.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$59.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$70.87
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$59.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.06
|
| 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 |
$76.78
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$59.06
|
|
|
US SOFT TISSUE EXT LIMITED(T
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.90 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
US SOFT TISSUE EXT LIMITED(T
|
Facility
|
OP
|
$813.00
|
|
|
Service Code
|
HCPCS 76882
|
| Hospital Charge Code |
402T0056
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$780.48 |
| Rate for Payer: Aetna Commercial |
$626.01
|
| Rate for Payer: Anthem Medicaid |
$279.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$674.79
|
| Rate for Payer: First Health Commercial |
$772.35
|
| Rate for Payer: Humana Commercial |
$691.05
|
| Rate for Payer: Humana KY Medicaid |
$279.59
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$666.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$715.44
|
| Rate for Payer: Ohio Health Group HMO |
$609.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.97
|
| Rate for Payer: PHCS Commercial |
$780.48
|
| Rate for Payer: United Healthcare All Payer |
$715.44
|
|
|
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 |
$544.20 |
| Rate for Payer: Aetna Commercial |
$188.50
|
| Rate for Payer: Ambetter Exchange |
$163.84
|
| Rate for Payer: Anthem Medicaid |
$86.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$163.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$163.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.84
|
| 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 |
$212.99
|
| Rate for Payer: UHCCP Medicaid |
$317.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$163.84
|
|
