|
BX/CURETT OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761T2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$606.72 |
| Rate for Payer: Aetna Commercial |
$486.64
|
| Rate for Payer: Anthem Medicaid |
$217.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cigna Commercial |
$524.56
|
| Rate for Payer: First Health Commercial |
$600.40
|
| Rate for Payer: Humana Commercial |
$537.20
|
| Rate for Payer: Humana KY Medicaid |
$217.34
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$219.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$518.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$466.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$556.16
|
| Rate for Payer: Ohio Health Group HMO |
$474.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.92
|
| Rate for Payer: PHCS Commercial |
$606.72
|
| Rate for Payer: United Healthcare All Payer |
$556.16
|
|
|
BX/CURETT OF CERVIX W/SCOPE(T
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761T2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$606.72 |
| Rate for Payer: Aetna Commercial |
$486.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$492.96
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cigna Commercial |
$524.56
|
| Rate for Payer: First Health Commercial |
$600.40
|
| Rate for Payer: Humana Commercial |
$537.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$518.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$466.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$556.16
|
| Rate for Payer: Ohio Health Group HMO |
$474.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.92
|
| Rate for Payer: PHCS Commercial |
$606.72
|
| Rate for Payer: United Healthcare All Payer |
$556.16
|
|
|
BX LEG ANKLE DEEP SOFT TISSUE
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 27614
|
| Hospital Charge Code |
76100893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
BX LEG ANKLE DEEP SOFT TISSUE
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 27614
|
| Hospital Charge Code |
76100893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.79 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$601.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.79
|
| Rate for Payer: Anthem Medicaid |
$225.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$663.56
|
| Rate for Payer: Healthspan PPO |
$710.51
|
| Rate for Payer: Humana Medicaid |
$225.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$508.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.58
|
| Rate for Payer: Molina Healthcare Passport |
$225.08
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$222.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
|
|
BX LEG ANKLE DEEP SOFT TISSUE
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 27614
|
| Hospital Charge Code |
76100893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| 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 |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
BX LEG ANKLE DEEP SOFT TISSU(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 27614
|
| Hospital Charge Code |
761P0893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.79 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$601.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.79
|
| Rate for Payer: Anthem Medicaid |
$225.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$663.56
|
| Rate for Payer: Healthspan PPO |
$710.51
|
| Rate for Payer: Humana Medicaid |
$225.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$508.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.58
|
| Rate for Payer: Molina Healthcare Passport |
$225.08
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$222.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
|
|
BX LIVER WITH OTHER PROCEDURE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
76101946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$156.91
|
| Rate for Payer: Anthem Medicaid |
$82.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$148.77
|
| Rate for Payer: Healthspan PPO |
$132.33
|
| Rate for Payer: Humana Medicaid |
$82.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.59
|
| Rate for Payer: Molina Healthcare Passport |
$82.93
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.76
|
|
|
BX LIVER WITH OTHER PROCEDURE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
76101946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
BX LIVER WITH OTHER PROCEDURE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
76101946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.98
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
BX LIVER WITH OTHER PROCEDUR(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
761P1946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$156.91
|
| Rate for Payer: Anthem Medicaid |
$82.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$148.77
|
| Rate for Payer: Healthspan PPO |
$132.33
|
| Rate for Payer: Humana Medicaid |
$82.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.59
|
| Rate for Payer: Molina Healthcare Passport |
$82.93
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.76
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
76102625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$350.40 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$109.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
76102625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$482.62 |
| Rate for Payer: Aetna Commercial |
$251.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.57
|
| Rate for Payer: Anthem Medicaid |
$121.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$482.62
|
| Rate for Payer: Healthspan PPO |
$423.63
|
| Rate for Payer: Humana Medicaid |
$121.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.74
|
| Rate for Payer: Molina Healthcare Passport |
$121.31
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.52
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
76102625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem Medicaid |
$125.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$302.95
|
| Rate for Payer: First Health Commercial |
$346.75
|
| Rate for Payer: Humana Commercial |
$310.25
|
| Rate for Payer: Humana KY Medicaid |
$125.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$126.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$299.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$269.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$128.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$321.20
|
| Rate for Payer: Ohio Health Group HMO |
$273.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.15
|
| Rate for Payer: PHCS Commercial |
$350.40
|
| Rate for Payer: United Healthcare All Payer |
$321.20
|
|
|
BX OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 57460
|
| Hospital Charge Code |
761P2625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.57 |
| Max. Negotiated Rate |
$482.62 |
| Rate for Payer: Aetna Commercial |
$251.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.57
|
| Rate for Payer: Anthem Medicaid |
$121.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$482.62
|
| Rate for Payer: Healthspan PPO |
$423.63
|
| Rate for Payer: Humana Medicaid |
$121.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.74
|
| Rate for Payer: Molina Healthcare Passport |
$121.31
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.52
|
|
|
BX PLEURA PERC NEEDLE
|
Professional
|
Both
|
$2,216.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
76101186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$2,216.00 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$94.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,216.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cigna Commercial |
$139.32
|
| Rate for Payer: Healthspan PPO |
$189.63
|
| Rate for Payer: Humana Medicaid |
$94.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.15
|
| Rate for Payer: Molina Healthcare Passport |
$94.26
|
| Rate for Payer: Multiplan PHCS |
$1,329.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,551.20
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.20
|
|
|
BX PLEURA PERC NEEDLE
|
Facility
|
OP
|
$2,216.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
76101186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.08 |
| Max. Negotiated Rate |
$2,127.36 |
| Rate for Payer: Aetna Commercial |
$1,706.32
|
| Rate for Payer: Anthem Medicaid |
$762.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cigna Commercial |
$1,839.28
|
| Rate for Payer: First Health Commercial |
$2,105.20
|
| Rate for Payer: Humana Commercial |
$1,883.60
|
| Rate for Payer: Humana KY Medicaid |
$762.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$769.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$777.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.96
|
| Rate for Payer: PHCS Commercial |
$2,127.36
|
| Rate for Payer: United Healthcare All Payer |
$1,950.08
|
|
|
BX PLEURA PERC NEEDLE
|
Facility
|
IP
|
$2,216.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
76101186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.08 |
| Max. Negotiated Rate |
$2,127.36 |
| Rate for Payer: Aetna Commercial |
$1,706.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.48
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Cigna Commercial |
$1,839.28
|
| Rate for Payer: First Health Commercial |
$2,105.20
|
| Rate for Payer: Humana Commercial |
$1,883.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.96
|
| Rate for Payer: PHCS Commercial |
$2,127.36
|
| Rate for Payer: United Healthcare All Payer |
$1,950.08
|
|
|
BX PLEURA PERC NEEDLE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
761P1186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$94.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$139.32
|
| Rate for Payer: Healthspan PPO |
$189.63
|
| Rate for Payer: Humana Medicaid |
$94.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.15
|
| Rate for Payer: Molina Healthcare Passport |
$94.26
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.20
|
|
|
BX PLEURA PERC NEEDLE(T
|
Facility
|
OP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
761T1186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BX PLEURA PERC NEEDLE(T
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
761T1186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BX SOFT TISSUE - LEG OR ANKLE
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BX SOFT TISSUE - LEG OR ANKLE
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
BX SOFT TISSUE - LEG OR ANKLE
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
76100892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$73.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$355.61
|
| Rate for Payer: Healthspan PPO |
$309.21
|
| Rate for Payer: Humana Medicaid |
$73.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.09
|
| Rate for Payer: Molina Healthcare Passport |
$73.62
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.36
|
|
|
BX SOFT TISSUE - LEG OR ANKL(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 27613
|
| Hospital Charge Code |
761P0892
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.85
|
| Rate for Payer: Anthem Medicaid |
$73.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$355.61
|
| Rate for Payer: Healthspan PPO |
$309.21
|
| Rate for Payer: Humana Medicaid |
$73.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$204.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.09
|
| Rate for Payer: Molina Healthcare Passport |
$73.62
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$85.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.36
|
|
|
BX SOFT TISS UPPER ARM SUPRF
|
Facility
|
OP
|
$4,114.50
|
|
|
Service Code
|
HCPCS 24065
|
| Hospital Charge Code |
76100498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.88 |
| Max. Negotiated Rate |
$3,949.92 |
| Rate for Payer: Aetna Commercial |
$3,168.16
|
| Rate for Payer: Anthem Medicaid |
$1,414.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,209.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,057.25
|
| Rate for Payer: Cash Price |
$2,057.25
|
| Rate for Payer: Cigna Commercial |
$3,415.04
|
| Rate for Payer: First Health Commercial |
$3,908.78
|
| Rate for Payer: Humana Commercial |
$3,497.32
|
| Rate for Payer: Humana KY Medicaid |
$1,414.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,373.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,036.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,620.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,085.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.50
|
| Rate for Payer: PHCS Commercial |
$3,949.92
|
| Rate for Payer: United Healthcare All Payer |
$3,620.76
|
|
