|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.40 |
| Max. Negotiated Rate |
$1,150.08 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,150.08 |
| Rate for Payer: Aetna Commercial |
$922.46
|
| Rate for Payer: Anthem Medicaid |
$411.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$994.34
|
| Rate for Payer: First Health Commercial |
$1,138.10
|
| Rate for Payer: Humana Commercial |
$1,018.30
|
| Rate for Payer: Humana KY Medicaid |
$411.99
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$416.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.24
|
| Rate for Payer: Ohio Health Group HMO |
$898.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.62
|
| Rate for Payer: PHCS Commercial |
$1,150.08
|
| Rate for Payer: United Healthcare All Payer |
$1,054.24
|
|
|
BX/CURETT OF CERVIX W/SCOPE
|
Professional
|
Both
|
$1,198.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
76102194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$718.80 |
| Rate for Payer: Aetna Commercial |
$209.56
|
| Rate for Payer: Ambetter Exchange |
$126.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.03
|
| Rate for Payer: Anthem Medicaid |
$76.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.05
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cash Price |
$599.00
|
| Rate for Payer: Cigna Commercial |
$232.91
|
| Rate for Payer: Healthspan PPO |
$226.24
|
| Rate for Payer: Humana Medicaid |
$76.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.56
|
| Rate for Payer: Molina Healthcare Passport |
$76.04
|
| Rate for Payer: Multiplan PHCS |
$718.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.72
|
| Rate for Payer: UHCCP Medicaid |
$108.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.71
|
|
|
BX/CURETT OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761P2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.04 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$209.56
|
| Rate for Payer: Ambetter Exchange |
$126.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$103.03
|
| Rate for Payer: Anthem Medicaid |
$76.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.05
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$232.91
|
| Rate for Payer: Healthspan PPO |
$226.24
|
| Rate for Payer: Humana Medicaid |
$76.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.56
|
| Rate for Payer: Molina Healthcare Passport |
$76.04
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.72
|
| Rate for Payer: UHCCP Medicaid |
$108.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.71
|
|
|
BX/CURETT OF CERVIX W/SCOPE(T
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761T2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.90 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
BX/CURETT OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
HCPCS 57454
|
| Hospital Charge Code |
761T2194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.44 |
| Max. Negotiated Rate |
$646.08 |
| Rate for Payer: Aetna Commercial |
$518.21
|
| Rate for Payer: Anthem Medicaid |
$231.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$524.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cigna Commercial |
$558.59
|
| Rate for Payer: First Health Commercial |
$639.35
|
| Rate for Payer: Humana Commercial |
$572.05
|
| Rate for Payer: Humana KY Medicaid |
$231.44
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$233.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$551.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$496.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$592.24
|
| Rate for Payer: Ohio Health Group HMO |
$504.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.37
|
| Rate for Payer: PHCS Commercial |
$646.08
|
| Rate for Payer: United Healthcare All Payer |
$592.24
|
|
|
BX DONE W/COLPOSCOPY ADD-ON
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 58110
|
| Hospital Charge Code |
76102997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$75.90 |
| Rate for Payer: Aetna Commercial |
$64.24
|
| Rate for Payer: Ambetter Exchange |
$38.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$30.63
|
| Rate for Payer: Anthem Medicaid |
$39.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.07
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$75.90
|
| Rate for Payer: Healthspan PPO |
$72.04
|
| Rate for Payer: Humana Medicaid |
$39.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.99
|
| Rate for Payer: Molina Healthcare Passport |
$39.21
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.91
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.39
|
|
|
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 |
$710.51 |
| Rate for Payer: Aetna Commercial |
$601.38
|
| Rate for Payer: Ambetter Exchange |
$391.88
|
| 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 Individual/Medicaid |
$391.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$470.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.88
|
| 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 |
$509.44
|
| Rate for Payer: UHCCP Medicaid |
$222.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.88
|
|
|
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 |
$326.70 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
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 |
$285.00 |
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| 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 |
$710.51 |
| Rate for Payer: Aetna Commercial |
$601.38
|
| Rate for Payer: Ambetter Exchange |
$391.88
|
| 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 Individual/Medicaid |
$391.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$470.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.88
|
| 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 |
$509.44
|
| Rate for Payer: UHCCP Medicaid |
$222.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.88
|
|
|
BX LIVER WITH OTHER PROCEDURE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
76101946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| 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 |
$85.97
|
| 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 |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
BX LIVER WITH OTHER PROCEDURE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 47001
|
| Hospital Charge Code |
76101946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.00 |
| 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 |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
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 |
$156.91 |
| Rate for Payer: Aetna Commercial |
$156.91
|
| Rate for Payer: Ambetter Exchange |
$99.05
|
| Rate for Payer: Anthem Medicaid |
$82.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$99.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.05
|
| 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 |
$128.76
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.05
|
|
|
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 |
$156.91 |
| Rate for Payer: Aetna Commercial |
$156.91
|
| Rate for Payer: Ambetter Exchange |
$99.05
|
| Rate for Payer: Anthem Medicaid |
$82.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$99.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.05
|
| 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 |
$128.76
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.05
|
|
|
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 |
$109.50 |
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| 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: Ambetter Exchange |
$151.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.57
|
| Rate for Payer: Anthem Medicaid |
$148.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.18
|
| 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 |
$148.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.37
|
| Rate for Payer: Molina Healthcare Passport |
$148.40
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.37
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.82
|
|
|
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 |
$125.52 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$281.05
|
| Rate for Payer: Anthem Medicaid |
$125.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$284.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$317.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.85
|
| 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: Ambetter Exchange |
$151.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$99.57
|
| Rate for Payer: Anthem Medicaid |
$148.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$151.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$151.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.18
|
| 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 |
$148.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$151.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.37
|
| Rate for Payer: Molina Healthcare Passport |
$148.40
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.37
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$151.82
|
|
|
BX PLEURA PERC NEEDLE
|
Facility
|
OP
|
$2,216.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
76101186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.08 |
| 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 |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| 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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$1,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,927.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.04
|
| Rate for Payer: PHCS Commercial |
$2,127.36
|
| Rate for Payer: United Healthcare All Payer |
$1,950.08
|
|
|
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 |
$1,329.60 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Ambetter Exchange |
$78.52
|
| 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 Individual/Medicaid |
$78.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.52
|
| 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 |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.52
|
|
|
BX PLEURA PERC NEEDLE
|
Facility
|
IP
|
$2,216.00
|
|
|
Service Code
|
HCPCS 32400
|
| Hospital Charge Code |
76101186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.80 |
| 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 |
$1,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,927.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.04
|
| 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 |
$189.63 |
| Rate for Payer: Aetna Commercial |
$152.12
|
| Rate for Payer: Ambetter Exchange |
$78.52
|
| 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 Individual/Medicaid |
$78.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$78.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.52
|
| 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 |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$78.52
|
|
|
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 |
$589.80 |
| 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 |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
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 |
$676.11 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem Medicaid |
$676.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| 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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$1,572.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,710.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.54
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
