CLOSE OF GASTROSTOMY, SURGICAL
|
Professional
|
Both
|
$1,845.00
|
|
Service Code
|
HCPCS 43870
|
Hospital Charge Code |
76101800
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$374.96 |
Max. Negotiated Rate |
$1,845.00 |
Rate for Payer: Aetna Commercial |
$1,009.54
|
Rate for Payer: Anthem Medicaid |
$374.96
|
Rate for Payer: Buckeye Medicare Advantage |
$1,845.00
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$931.23
|
Rate for Payer: Healthspan PPO |
$851.36
|
Rate for Payer: Humana Medicaid |
$374.96
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$901.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$382.46
|
Rate for Payer: Molina Healthcare Passport |
$374.96
|
Rate for Payer: Multiplan PHCS |
$1,107.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,291.50
|
Rate for Payer: UHCCP Medicaid |
$645.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$378.71
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Facility
|
OP
|
$1,845.00
|
|
Service Code
|
HCPCS 43870
|
Hospital Charge Code |
76101800
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$239.85 |
Max. Negotiated Rate |
$4,636.52 |
Rate for Payer: Aetna Commercial |
$1,420.65
|
Rate for Payer: Anthem Medicaid |
$634.50
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$3,311.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,636.52
|
Rate for Payer: CareSource Just4Me Medicare |
$4,470.93
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$1,531.35
|
Rate for Payer: First Health Commercial |
$1,752.75
|
Rate for Payer: Humana Commercial |
$1,568.25
|
Rate for Payer: Humana KY Medicaid |
$634.50
|
Rate for Payer: Humana Medicare Advantage |
$3,311.80
|
Rate for Payer: Kentucky WC Medicaid |
$640.95
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.16
|
Rate for Payer: Molina Healthcare Medicaid |
$647.23
|
Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$369.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$239.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.95
|
Rate for Payer: PHCS Commercial |
$1,771.20
|
Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Facility
|
IP
|
$1,845.00
|
|
Service Code
|
HCPCS 43870
|
Hospital Charge Code |
76101800
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$239.85 |
Max. Negotiated Rate |
$1,771.20 |
Rate for Payer: Aetna Commercial |
$1,420.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$1,531.35
|
Rate for Payer: First Health Commercial |
$1,752.75
|
Rate for Payer: Humana Commercial |
$1,568.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$553.50
|
Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$369.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$239.85
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.95
|
Rate for Payer: PHCS Commercial |
$1,771.20
|
Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Professional
|
Both
|
$1,845.00
|
|
Service Code
|
HCPCS 43870
|
Hospital Charge Code |
761P1800
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$374.96 |
Max. Negotiated Rate |
$1,845.00 |
Rate for Payer: Aetna Commercial |
$1,009.54
|
Rate for Payer: Anthem Medicaid |
$374.96
|
Rate for Payer: Buckeye Medicare Advantage |
$1,845.00
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cash Price |
$922.50
|
Rate for Payer: Cigna Commercial |
$931.23
|
Rate for Payer: Healthspan PPO |
$851.36
|
Rate for Payer: Humana Medicaid |
$374.96
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$901.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$382.46
|
Rate for Payer: Molina Healthcare Passport |
$374.96
|
Rate for Payer: Multiplan PHCS |
$1,107.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,291.50
|
Rate for Payer: UHCCP Medicaid |
$645.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$378.71
|
|
CLOSE OF RECTOVAGINAL FISTULA
|
Professional
|
Both
|
$2,200.00
|
|
Service Code
|
HCPCS 57305
|
Hospital Charge Code |
76102189
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$495.41 |
Max. Negotiated Rate |
$2,200.00 |
Rate for Payer: Aetna Commercial |
$1,347.09
|
Rate for Payer: Anthem Medicaid |
$495.41
|
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 |
$1,284.23
|
Rate for Payer: Healthspan PPO |
$1,304.32
|
Rate for Payer: Humana Medicaid |
$495.41
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.67
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.32
|
Rate for Payer: Molina Healthcare Passport |
$495.41
|
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 |
$500.36
|
|
CLOSE OF RECTOVAGINAL FISTULA
|
Facility
|
OP
|
$2,200.00
|
|
Service Code
|
HCPCS 57305
|
Hospital Charge Code |
76102189
|
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
|
|
CLOSE OF RECTOVAGINAL FISTULA
|
Facility
|
IP
|
$2,200.00
|
|
Service Code
|
HCPCS 57305
|
Hospital Charge Code |
76102189
|
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
|
|
CLOSE OF RECTOVAGINAL FISTUL(P
|
Professional
|
Both
|
$2,200.00
|
|
Service Code
|
HCPCS 57305
|
Hospital Charge Code |
761P2189
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$495.41 |
Max. Negotiated Rate |
$2,200.00 |
Rate for Payer: Aetna Commercial |
$1,347.09
|
Rate for Payer: Anthem Medicaid |
$495.41
|
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 |
$1,284.23
|
Rate for Payer: Healthspan PPO |
$1,304.32
|
Rate for Payer: Humana Medicaid |
$495.41
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.67
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.32
|
Rate for Payer: Molina Healthcare Passport |
$495.41
|
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 |
$500.36
|
|
CLOSE VESICOVAGINAL FISTULA
|
Professional
|
Both
|
$3,800.00
|
|
Service Code
|
HCPCS 51900
|
Hospital Charge Code |
76102078
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$689.18 |
Max. Negotiated Rate |
$3,800.00 |
Rate for Payer: Aetna Commercial |
$1,331.53
|
Rate for Payer: Anthem Medicaid |
$689.18
|
Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cigna Commercial |
$1,199.56
|
Rate for Payer: Healthspan PPO |
$1,064.68
|
Rate for Payer: Humana Medicaid |
$689.18
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,114.48
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.96
|
Rate for Payer: Molina Healthcare Passport |
$689.18
|
Rate for Payer: Multiplan PHCS |
$2,280.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
Rate for Payer: UHCCP Medicaid |
$1,330.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$696.07
|
|
CLOSE VESICOVAGINAL FISTULA
|
Facility
|
OP
|
$3,800.00
|
|
Service Code
|
HCPCS 51900
|
Hospital Charge Code |
76102078
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$494.00 |
Max. Negotiated Rate |
$3,648.00 |
Rate for Payer: Aetna Commercial |
$2,926.00
|
Rate for Payer: Anthem Medicaid |
$1,306.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cigna Commercial |
$3,154.00
|
Rate for Payer: First Health Commercial |
$3,610.00
|
Rate for Payer: Humana Commercial |
$3,230.00
|
Rate for Payer: Humana KY Medicaid |
$1,306.82
|
Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
Rate for Payer: PHCS Commercial |
$3,648.00
|
Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
CLOSE VESICOVAGINAL FISTULA
|
Facility
|
IP
|
$3,800.00
|
|
Service Code
|
HCPCS 51900
|
Hospital Charge Code |
76102078
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$494.00 |
Max. Negotiated Rate |
$3,648.00 |
Rate for Payer: Aetna Commercial |
$2,926.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cigna Commercial |
$3,154.00
|
Rate for Payer: First Health Commercial |
$3,610.00
|
Rate for Payer: Humana Commercial |
$3,230.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
Rate for Payer: PHCS Commercial |
$3,648.00
|
Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
CLOSE VESICOVAGINAL FISTULA(P
|
Professional
|
Both
|
$3,800.00
|
|
Service Code
|
HCPCS 51900
|
Hospital Charge Code |
761P2078
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$689.18 |
Max. Negotiated Rate |
$3,800.00 |
Rate for Payer: Aetna Commercial |
$1,331.53
|
Rate for Payer: Anthem Medicaid |
$689.18
|
Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cash Price |
$1,900.00
|
Rate for Payer: Cigna Commercial |
$1,199.56
|
Rate for Payer: Healthspan PPO |
$1,064.68
|
Rate for Payer: Humana Medicaid |
$689.18
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,114.48
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.96
|
Rate for Payer: Molina Healthcare Passport |
$689.18
|
Rate for Payer: Multiplan PHCS |
$2,280.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
Rate for Payer: UHCCP Medicaid |
$1,330.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$696.07
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
IP
|
$235.00
|
|
Hospital Charge Code |
45000336
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$30.55 |
Max. Negotiated Rate |
$225.60 |
Rate for Payer: Aetna Commercial |
$180.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
Rate for Payer: Cash Price |
$117.50
|
Rate for Payer: Cigna Commercial |
$195.05
|
Rate for Payer: First Health Commercial |
$223.25
|
Rate for Payer: Humana Commercial |
$199.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
Rate for Payer: Ohio Health Group HMO |
$176.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
Rate for Payer: PHCS Commercial |
$225.60
|
Rate for Payer: United Healthcare All Payer |
$206.80
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
IP
|
$225.00
|
|
Hospital Charge Code |
76102564
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$216.00 |
Rate for Payer: Aetna Commercial |
$173.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
Rate for Payer: Cash Price |
$112.50
|
Rate for Payer: Cigna Commercial |
$186.75
|
Rate for Payer: First Health Commercial |
$213.75
|
Rate for Payer: Humana Commercial |
$191.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
Rate for Payer: Ohio Health Group HMO |
$168.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
Rate for Payer: PHCS Commercial |
$216.00
|
Rate for Payer: United Healthcare All Payer |
$198.00
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
OP
|
$235.00
|
|
Hospital Charge Code |
45000336
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$30.55 |
Max. Negotiated Rate |
$225.60 |
Rate for Payer: Aetna Commercial |
$180.95
|
Rate for Payer: Anthem Medicaid |
$80.82
|
Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
Rate for Payer: Cash Price |
$117.50
|
Rate for Payer: Cigna Commercial |
$195.05
|
Rate for Payer: First Health Commercial |
$223.25
|
Rate for Payer: Humana Commercial |
$199.75
|
Rate for Payer: Humana KY Medicaid |
$80.82
|
Rate for Payer: Kentucky WC Medicaid |
$81.64
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
Rate for Payer: Ohio Health Group HMO |
$176.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
Rate for Payer: PHCS Commercial |
$225.60
|
Rate for Payer: United Healthcare All Payer |
$206.80
|
|
CLOS TX FX/DISLC FING/TOE/TRUN
|
Facility
|
OP
|
$225.00
|
|
Hospital Charge Code |
76102564
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$29.25 |
Max. Negotiated Rate |
$216.00 |
Rate for Payer: Aetna Commercial |
$173.25
|
Rate for Payer: Anthem Medicaid |
$77.38
|
Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
Rate for Payer: Cash Price |
$112.50
|
Rate for Payer: Cigna Commercial |
$186.75
|
Rate for Payer: First Health Commercial |
$213.75
|
Rate for Payer: Humana Commercial |
$191.25
|
Rate for Payer: Humana KY Medicaid |
$77.38
|
Rate for Payer: Kentucky WC Medicaid |
$78.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
Rate for Payer: Molina Healthcare Medicaid |
$78.93
|
Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
Rate for Payer: Ohio Health Group HMO |
$168.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$45.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$29.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.75
|
Rate for Payer: PHCS Commercial |
$216.00
|
Rate for Payer: United Healthcare All Payer |
$198.00
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Facility
|
OP
|
$1,300.00
|
|
Service Code
|
HCPCS 44620
|
Hospital Charge Code |
76101859
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$169.00 |
Max. Negotiated Rate |
$1,248.00 |
Rate for Payer: Aetna Commercial |
$1,001.00
|
Rate for Payer: Anthem Medicaid |
$447.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,079.00
|
Rate for Payer: First Health Commercial |
$1,235.00
|
Rate for Payer: Humana Commercial |
$1,105.00
|
Rate for Payer: Humana KY Medicaid |
$447.07
|
Rate for Payer: Kentucky WC Medicaid |
$451.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
Rate for Payer: Ohio Health Group HMO |
$975.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
Rate for Payer: PHCS Commercial |
$1,248.00
|
Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Professional
|
Both
|
$1,300.00
|
|
Service Code
|
HCPCS 44620
|
Hospital Charge Code |
76101859
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$455.00 |
Max. Negotiated Rate |
$1,300.00 |
Rate for Payer: Aetna Commercial |
$1,237.24
|
Rate for Payer: Anthem Medicaid |
$473.91
|
Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,144.44
|
Rate for Payer: Healthspan PPO |
$1,043.39
|
Rate for Payer: Humana Medicaid |
$473.91
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.39
|
Rate for Payer: Molina Healthcare Passport |
$473.91
|
Rate for Payer: Multiplan PHCS |
$780.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
Rate for Payer: UHCCP Medicaid |
$455.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$478.65
|
|
CLOSURE ENTEROSTOMY - LRG/SM
|
Facility
|
IP
|
$1,300.00
|
|
Service Code
|
HCPCS 44620
|
Hospital Charge Code |
76101859
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$169.00 |
Max. Negotiated Rate |
$1,248.00 |
Rate for Payer: Aetna Commercial |
$1,001.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,079.00
|
Rate for Payer: First Health Commercial |
$1,235.00
|
Rate for Payer: Humana Commercial |
$1,105.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
Rate for Payer: Ohio Health Group HMO |
$975.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
Rate for Payer: PHCS Commercial |
$1,248.00
|
Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
CLOSURE ENTEROSTOMY - LRG/SM(P
|
Professional
|
Both
|
$1,300.00
|
|
Service Code
|
HCPCS 44620
|
Hospital Charge Code |
761P1859
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$455.00 |
Max. Negotiated Rate |
$1,300.00 |
Rate for Payer: Aetna Commercial |
$1,237.24
|
Rate for Payer: Anthem Medicaid |
$473.91
|
Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cash Price |
$650.00
|
Rate for Payer: Cigna Commercial |
$1,144.44
|
Rate for Payer: Healthspan PPO |
$1,043.39
|
Rate for Payer: Humana Medicaid |
$473.91
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.39
|
Rate for Payer: Molina Healthcare Passport |
$473.91
|
Rate for Payer: Multiplan PHCS |
$780.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
Rate for Payer: UHCCP Medicaid |
$455.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$478.65
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Professional
|
Both
|
$2,050.00
|
|
Service Code
|
HCPCS 44625
|
Hospital Charge Code |
76101860
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$661.34 |
Max. Negotiated Rate |
$2,050.00 |
Rate for Payer: Aetna Commercial |
$1,468.43
|
Rate for Payer: Anthem Medicaid |
$661.34
|
Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,365.06
|
Rate for Payer: Healthspan PPO |
$1,238.36
|
Rate for Payer: Humana Medicaid |
$661.34
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.41
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.57
|
Rate for Payer: Molina Healthcare Passport |
$661.34
|
Rate for Payer: Multiplan PHCS |
$1,230.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
Rate for Payer: UHCCP Medicaid |
$717.50
|
Rate for Payer: Wellcare CHIP/Medicaid |
$667.95
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Facility
|
OP
|
$2,050.00
|
|
Service Code
|
HCPCS 44625
|
Hospital Charge Code |
76101860
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$266.50 |
Max. Negotiated Rate |
$1,968.00 |
Rate for Payer: Aetna Commercial |
$1,578.50
|
Rate for Payer: Anthem Medicaid |
$705.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,701.50
|
Rate for Payer: First Health Commercial |
$1,947.50
|
Rate for Payer: Humana Commercial |
$1,742.50
|
Rate for Payer: Humana KY Medicaid |
$705.00
|
Rate for Payer: Kentucky WC Medicaid |
$712.17
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
Rate for Payer: PHCS Commercial |
$1,968.00
|
Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
CLOSURE OF ENTEROSTOMY - LARG
|
Facility
|
IP
|
$2,050.00
|
|
Service Code
|
HCPCS 44625
|
Hospital Charge Code |
76101860
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$266.50 |
Max. Negotiated Rate |
$1,968.00 |
Rate for Payer: Aetna Commercial |
$1,578.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,701.50
|
Rate for Payer: First Health Commercial |
$1,947.50
|
Rate for Payer: Humana Commercial |
$1,742.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
Rate for Payer: PHCS Commercial |
$1,968.00
|
Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
CLOSURE OF ENTEROSTOMY - LAR(P
|
Professional
|
Both
|
$2,050.00
|
|
Service Code
|
HCPCS 44625
|
Hospital Charge Code |
761P1860
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$661.34 |
Max. Negotiated Rate |
$2,050.00 |
Rate for Payer: Aetna Commercial |
$1,468.43
|
Rate for Payer: Anthem Medicaid |
$661.34
|
Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cash Price |
$1,025.00
|
Rate for Payer: Cigna Commercial |
$1,365.06
|
Rate for Payer: Healthspan PPO |
$1,238.36
|
Rate for Payer: Humana Medicaid |
$661.34
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.41
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$674.57
|
Rate for Payer: Molina Healthcare Passport |
$661.34
|
Rate for Payer: Multiplan PHCS |
$1,230.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
Rate for Payer: UHCCP Medicaid |
$717.50
|
Rate for Payer: Wellcare CHIP/Medicaid |
$667.95
|
|
CLOSURE OF EYELID BY SUTURE
|
Professional
|
Both
|
$3,892.28
|
|
Service Code
|
HCPCS 67875
|
Hospital Charge Code |
76102392
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$47.59 |
Max. Negotiated Rate |
$3,892.28 |
Rate for Payer: Aetna Commercial |
$130.56
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
Rate for Payer: Anthem Medicaid |
$88.91
|
Rate for Payer: Buckeye Medicare Advantage |
$3,892.28
|
Rate for Payer: Cash Price |
$1,946.14
|
Rate for Payer: Cash Price |
$1,946.14
|
Rate for Payer: Cigna Commercial |
$126.14
|
Rate for Payer: Healthspan PPO |
$198.42
|
Rate for Payer: Humana Medicaid |
$88.91
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.02
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.69
|
Rate for Payer: Molina Healthcare Passport |
$88.91
|
Rate for Payer: Multiplan PHCS |
$2,335.37
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,724.60
|
Rate for Payer: UHCCP Medicaid |
$49.97
|
Rate for Payer: Wellcare CHIP/Medicaid |
$89.80
|
|