|
BURCH PROCEDURE
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
76102073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
BURCH PROCEDURE
|
Facility
|
IP
|
$8,631.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
76102075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.03 |
| Max. Negotiated Rate |
$8,285.76 |
| Rate for Payer: Aetna Commercial |
$6,645.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,732.18
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cigna Commercial |
$7,163.73
|
| Rate for Payer: First Health Commercial |
$8,199.45
|
| Rate for Payer: Humana Commercial |
$7,336.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,077.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,369.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,589.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.61
|
| Rate for Payer: PHCS Commercial |
$8,285.76
|
| Rate for Payer: United Healthcare All Payer |
$7,595.28
|
|
|
BURCH PROCEDURE
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
76102073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
BURCH PROCEDURE
|
Facility
|
OP
|
$8,631.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
76102075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.03 |
| Max. Negotiated Rate |
$8,285.76 |
| Rate for Payer: Aetna Commercial |
$6,645.87
|
| Rate for Payer: Anthem Medicaid |
$2,968.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,732.18
|
| 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 |
$4,315.50
|
| Rate for Payer: Cash Price |
$4,315.50
|
| Rate for Payer: Cigna Commercial |
$7,163.73
|
| Rate for Payer: First Health Commercial |
$8,199.45
|
| Rate for Payer: Humana Commercial |
$7,336.35
|
| Rate for Payer: Humana KY Medicaid |
$2,968.20
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,998.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,077.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,369.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,027.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,726.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,675.61
|
| Rate for Payer: PHCS Commercial |
$8,285.76
|
| Rate for Payer: United Healthcare All Payer |
$7,595.28
|
|
|
BURCH PROCEDURE(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
761P2075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$944.80
|
| Rate for Payer: Anthem Medicaid |
$579.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$857.58
|
| Rate for Payer: Healthspan PPO |
$755.46
|
| Rate for Payer: Humana Medicaid |
$579.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$802.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.19
|
| Rate for Payer: Molina Healthcare Passport |
$579.60
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.40
|
|
|
BURCH PROCEDURE(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 51840
|
| Hospital Charge Code |
761P2073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.89 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,044.04
|
| Rate for Payer: Anthem Medicaid |
$564.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$969.22
|
| Rate for Payer: Healthspan PPO |
$834.80
|
| Rate for Payer: Humana Medicaid |
$564.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$893.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.19
|
| Rate for Payer: Molina Healthcare Passport |
$564.89
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.54
|
|
|
BURCH PROCEDURE(T
|
Facility
|
OP
|
$6,031.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
761T2075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.03 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$4,643.87
|
| Rate for Payer: Anthem Medicaid |
$2,074.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,704.18
|
| 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 |
$3,015.50
|
| Rate for Payer: Cash Price |
$3,015.50
|
| Rate for Payer: Cigna Commercial |
$5,005.73
|
| Rate for Payer: First Health Commercial |
$5,729.45
|
| Rate for Payer: Humana Commercial |
$5,126.35
|
| Rate for Payer: Humana KY Medicaid |
$2,074.06
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,095.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,945.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,115.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$784.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.61
|
| Rate for Payer: PHCS Commercial |
$5,789.76
|
| Rate for Payer: United Healthcare All Payer |
$5,307.28
|
|
|
BURCH PROCEDURE(T
|
Facility
|
IP
|
$6,031.00
|
|
|
Service Code
|
HCPCS 51845
|
| Hospital Charge Code |
761T2075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.03 |
| Max. Negotiated Rate |
$5,789.76 |
| Rate for Payer: Aetna Commercial |
$4,643.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,704.18
|
| Rate for Payer: Cash Price |
$3,015.50
|
| Rate for Payer: Cigna Commercial |
$5,005.73
|
| Rate for Payer: First Health Commercial |
$5,729.45
|
| Rate for Payer: Humana Commercial |
$5,126.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,945.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,307.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,523.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$784.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.61
|
| Rate for Payer: PHCS Commercial |
$5,789.76
|
| Rate for Payer: United Healthcare All Payer |
$5,307.28
|
|
|
BUSPAR 15MG TABLET
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
25002913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem Medicaid |
$1.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Humana KY Medicaid |
$1.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
BUSPAR 15MG TABLET
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
25002913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cigna Commercial |
$3.86
|
| Rate for Payer: First Health Commercial |
$4.42
|
| Rate for Payer: Humana Commercial |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.09
|
| Rate for Payer: Ohio Health Group HMO |
$3.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Payer |
$4.09
|
|
|
BUSPAR (BUSPIRONE) 5MG/1TAB
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 51079098520
|
| Hospital Charge Code |
25000351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
BUSPAR (BUSPIRONE) 5MG/1TAB
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 51079098520
|
| Hospital Charge Code |
25000351
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cigna Commercial |
$3.57
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.66
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.33
|
| Rate for Payer: PHCS Commercial |
$4.13
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
BUTTOCK FASCIOTOMY W/DBRDMT
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 27057
|
| Hospital Charge Code |
76102803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$1,601.77 |
| Rate for Payer: Aetna Commercial |
$1,406.18
|
| Rate for Payer: Anthem Medicaid |
$730.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,601.77
|
| Rate for Payer: Healthspan PPO |
$1,273.69
|
| Rate for Payer: Humana Medicaid |
$730.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,150.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.78
|
| Rate for Payer: Molina Healthcare Passport |
$730.18
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$737.48
|
|
|
BUTTOCK FASCIOTOMY W/DBRDMT
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 27057
|
| Hospital Charge Code |
76102803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem Medicaid |
$355.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Humana KY Medicaid |
$355.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$359.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$363.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
BUTTOCK FASCIOTOMY W/DBRDMT
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 27057
|
| Hospital Charge Code |
76102803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
BUTTON ARCOS TROCH 25MM
|
Facility
|
OP
|
$7,552.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.80 |
| Max. Negotiated Rate |
$7,250.21 |
| Rate for Payer: Aetna Commercial |
$5,815.27
|
| Rate for Payer: Anthem Medicaid |
$2,597.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,890.79
|
| Rate for Payer: Cash Price |
$3,776.15
|
| Rate for Payer: Cigna Commercial |
$6,268.41
|
| Rate for Payer: First Health Commercial |
$7,174.68
|
| Rate for Payer: Humana Commercial |
$6,419.46
|
| Rate for Payer: Humana KY Medicaid |
$2,597.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,623.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,192.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,573.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,649.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,646.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,664.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,341.21
|
| Rate for Payer: PHCS Commercial |
$7,250.21
|
| Rate for Payer: United Healthcare All Payer |
$6,646.02
|
|
|
BUTTON ARCOS TROCH 25MM
|
Facility
|
IP
|
$7,552.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.80 |
| Max. Negotiated Rate |
$7,250.21 |
| Rate for Payer: Aetna Commercial |
$5,815.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,890.79
|
| Rate for Payer: Cash Price |
$3,776.15
|
| Rate for Payer: Cigna Commercial |
$6,268.41
|
| Rate for Payer: First Health Commercial |
$7,174.68
|
| Rate for Payer: Humana Commercial |
$6,419.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,192.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,573.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,265.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,646.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,664.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,510.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,341.21
|
| Rate for Payer: PHCS Commercial |
$7,250.21
|
| Rate for Payer: United Healthcare All Payer |
$6,646.02
|
|
|
BUTTON LARGE PEC KIT
|
Facility
|
OP
|
$9,123.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.07 |
| Max. Negotiated Rate |
$8,758.68 |
| Rate for Payer: Aetna Commercial |
$7,025.19
|
| Rate for Payer: Anthem Medicaid |
$3,137.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,116.42
|
| Rate for Payer: Cash Price |
$4,561.81
|
| Rate for Payer: Cigna Commercial |
$7,572.60
|
| Rate for Payer: First Health Commercial |
$8,667.44
|
| Rate for Payer: Humana Commercial |
$7,755.08
|
| Rate for Payer: Humana KY Medicaid |
$3,137.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,169.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,481.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,733.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,737.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,200.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,028.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,842.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,824.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.32
|
| Rate for Payer: PHCS Commercial |
$8,758.68
|
| Rate for Payer: United Healthcare All Payer |
$8,028.79
|
|
|
BUTTON LARGE PEC KIT
|
Facility
|
IP
|
$9,123.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,186.07 |
| Max. Negotiated Rate |
$8,758.68 |
| Rate for Payer: Aetna Commercial |
$7,025.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,116.42
|
| Rate for Payer: Cash Price |
$4,561.81
|
| Rate for Payer: Cigna Commercial |
$7,572.60
|
| Rate for Payer: First Health Commercial |
$8,667.44
|
| Rate for Payer: Humana Commercial |
$7,755.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,481.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,733.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,737.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,028.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,842.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,824.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.32
|
| Rate for Payer: PHCS Commercial |
$8,758.68
|
| Rate for Payer: United Healthcare All Payer |
$8,028.79
|
|
|
BX ANORECTAL ANAL APROACH
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
76101876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.11 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$406.58
|
| Rate for Payer: Anthem Medicaid |
$158.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$371.87
|
| Rate for Payer: Healthspan PPO |
$342.87
|
| Rate for Payer: Humana Medicaid |
$158.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.27
|
| Rate for Payer: Molina Healthcare Passport |
$158.11
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.69
|
|
|
BX ANORECTAL ANAL APROACH
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
76101876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
BX ANORECTAL ANAL APROACH
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
76101876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
BX ANORECTAL ANAL APROACH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 45100
|
| Hospital Charge Code |
761P1876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.11 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$406.58
|
| Rate for Payer: Anthem Medicaid |
$158.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$371.87
|
| Rate for Payer: Healthspan PPO |
$342.87
|
| Rate for Payer: Humana Medicaid |
$158.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$368.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.27
|
| Rate for Payer: Molina Healthcare Passport |
$158.11
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.69
|
|
|
BX BONE SUPRFCL OPEN
|
Facility
|
IP
|
$4,783.88
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
76100330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$621.90 |
| Max. Negotiated Rate |
$4,592.52 |
| Rate for Payer: Aetna Commercial |
$3,683.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.43
|
| Rate for Payer: Cash Price |
$2,391.94
|
| Rate for Payer: Cigna Commercial |
$3,970.62
|
| Rate for Payer: First Health Commercial |
$4,544.69
|
| Rate for Payer: Humana Commercial |
$4,066.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,587.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.00
|
| Rate for Payer: PHCS Commercial |
$4,592.52
|
| Rate for Payer: United Healthcare All Payer |
$4,209.81
|
|
|
BX BONE SUPRFCL OPEN
|
Facility
|
OP
|
$4,783.88
|
|
|
Service Code
|
HCPCS 20240
|
| Hospital Charge Code |
76100330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$621.90 |
| Max. Negotiated Rate |
$4,592.52 |
| Rate for Payer: Aetna Commercial |
$3,683.59
|
| Rate for Payer: Anthem Medicaid |
$1,645.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,731.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,391.94
|
| Rate for Payer: Cash Price |
$2,391.94
|
| Rate for Payer: Cigna Commercial |
$3,970.62
|
| Rate for Payer: First Health Commercial |
$4,544.69
|
| Rate for Payer: Humana Commercial |
$4,066.30
|
| Rate for Payer: Humana KY Medicaid |
$1,645.18
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,661.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,922.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,530.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,678.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,209.81
|
| Rate for Payer: Ohio Health Group HMO |
$3,587.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.00
|
| Rate for Payer: PHCS Commercial |
$4,592.52
|
| Rate for Payer: United Healthcare All Payer |
$4,209.81
|
|
