|
COLOSTOMY OR SKIN LEVEL CECOST
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.55 |
| Max. Negotiated Rate |
$1,721.18 |
| Rate for Payer: Aetna Commercial |
$1,721.18
|
| Rate for Payer: Anthem Medicaid |
$572.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,613.00
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,598.46
|
| Rate for Payer: Healthspan PPO |
$1,451.51
|
| Rate for Payer: Humana Medicaid |
$572.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,529.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$583.91
|
| Rate for Payer: Molina Healthcare Passport |
$572.46
|
| Rate for Payer: Multiplan PHCS |
$967.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,129.10
|
| Rate for Payer: UHCCP Medicaid |
$564.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$578.18
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
COLOSTOMY OR SKIN LEVEL CECOST
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 44320
|
| Hospital Charge Code |
76101838
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
COLOSTOMY;WITH MULT BX COLON
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
76101839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$1,352.07
|
| Rate for Payer: Anthem Medicaid |
$591.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,269.87
|
| Rate for Payer: Healthspan PPO |
$1,140.22
|
| Rate for Payer: Humana Medicaid |
$591.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,238.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.32
|
| Rate for Payer: Molina Healthcare Passport |
$591.49
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.40
|
|
|
COLOSTOMY;WITH MULT BX COLON(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44322
|
| Hospital Charge Code |
761P1839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$1,352.07
|
| Rate for Payer: Anthem Medicaid |
$591.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,269.87
|
| Rate for Payer: Healthspan PPO |
$1,140.22
|
| Rate for Payer: Humana Medicaid |
$591.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,238.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$603.32
|
| Rate for Payer: Molina Healthcare Passport |
$591.49
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$597.40
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.56 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$1,420.93
|
| Rate for Payer: Anthem Medicaid |
$571.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,314.44
|
| Rate for Payer: Healthspan PPO |
$1,198.30
|
| Rate for Payer: Humana Medicaid |
$571.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,259.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.99
|
| Rate for Payer: Molina Healthcare Passport |
$571.56
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.28
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
COLOTOMY - FOR EXPLORATION -
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
76101807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.60
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$604.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
COLOTOMY - FOR EXPLORATION -(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 44025
|
| Hospital Charge Code |
761P1807
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.56 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$1,420.93
|
| Rate for Payer: Anthem Medicaid |
$571.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,950.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,314.44
|
| Rate for Payer: Healthspan PPO |
$1,198.30
|
| Rate for Payer: Humana Medicaid |
$571.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,259.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.99
|
| Rate for Payer: Molina Healthcare Passport |
$571.56
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,365.00
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.28
|
|
|
COLPOCLEISIS (LE FORTE)
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
76102172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
COLPOCLEISIS (LE FORTE)
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
76102172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
COLPOCLEISIS (LE FORTE)
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
76102172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.66 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$771.08
|
| Rate for Payer: Anthem Medicaid |
$421.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$751.67
|
| Rate for Payer: Healthspan PPO |
$746.60
|
| Rate for Payer: Humana Medicaid |
$421.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$662.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$430.09
|
| Rate for Payer: Molina Healthcare Passport |
$421.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.88
|
|
|
COLPOCLEISIS (LE FORTE)(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
761P2172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.66 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$771.08
|
| Rate for Payer: Anthem Medicaid |
$421.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$751.67
|
| Rate for Payer: Healthspan PPO |
$746.60
|
| Rate for Payer: Humana Medicaid |
$421.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$662.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$430.09
|
| Rate for Payer: Molina Healthcare Passport |
$421.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.88
|
|
|
COLPOPERINEORRHAPHY
|
Professional
|
Both
|
$7,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
76102179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.30 |
| Max. Negotiated Rate |
$7,560.63 |
| Rate for Payer: Aetna Commercial |
$551.66
|
| Rate for Payer: Anthem Medicaid |
$242.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,560.63
|
| Rate for Payer: Cash Price |
$3,780.32
|
| Rate for Payer: Cash Price |
$3,780.32
|
| Rate for Payer: Cigna Commercial |
$534.39
|
| Rate for Payer: Healthspan PPO |
$534.15
|
| Rate for Payer: Humana Medicaid |
$242.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.15
|
| Rate for Payer: Molina Healthcare Passport |
$242.30
|
| Rate for Payer: Multiplan PHCS |
$4,536.38
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,292.44
|
| Rate for Payer: UHCCP Medicaid |
$2,646.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.72
|
|
|
COLPOPERINEORRHAPHY
|
Facility
|
OP
|
$7,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
76102179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.88 |
| Max. Negotiated Rate |
$7,258.20 |
| Rate for Payer: Aetna Commercial |
$5,821.69
|
| Rate for Payer: Anthem Medicaid |
$2,600.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.29
|
| 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 |
$3,780.32
|
| Rate for Payer: Cash Price |
$3,780.32
|
| Rate for Payer: Cigna Commercial |
$6,275.32
|
| Rate for Payer: First Health Commercial |
$7,182.60
|
| Rate for Payer: Humana Commercial |
$6,426.54
|
| Rate for Payer: Humana KY Medicaid |
$2,600.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,626.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,199.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,579.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,343.80
|
| Rate for Payer: PHCS Commercial |
$7,258.20
|
| Rate for Payer: United Healthcare All Payer |
$6,653.35
|
|
|
COLPOPERINEORRHAPHY
|
Facility
|
IP
|
$7,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
76102179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.88 |
| Max. Negotiated Rate |
$7,258.20 |
| Rate for Payer: Aetna Commercial |
$5,821.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.29
|
| Rate for Payer: Cash Price |
$3,780.32
|
| Rate for Payer: Cigna Commercial |
$6,275.32
|
| Rate for Payer: First Health Commercial |
$7,182.60
|
| Rate for Payer: Humana Commercial |
$6,426.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,199.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,579.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,653.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,670.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,512.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,343.80
|
| Rate for Payer: PHCS Commercial |
$7,258.20
|
| Rate for Payer: United Healthcare All Payer |
$6,653.35
|
|
|
COLPOPERINEORRHAPHY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
761P2179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.30 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$551.66
|
| Rate for Payer: Anthem Medicaid |
$242.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$534.39
|
| Rate for Payer: Healthspan PPO |
$534.15
|
| Rate for Payer: Humana Medicaid |
$242.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$472.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.15
|
| Rate for Payer: Molina Healthcare Passport |
$242.30
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.72
|
|
|
COLPOPERINEORRHAPHY(T
|
Facility
|
OP
|
$6,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
761T2179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$852.88 |
| Max. Negotiated Rate |
$6,298.20 |
| Rate for Payer: Aetna Commercial |
$5,051.69
|
| Rate for Payer: Anthem Medicaid |
$2,256.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,117.29
|
| 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 |
$3,280.32
|
| Rate for Payer: Cash Price |
$3,280.32
|
| Rate for Payer: Cigna Commercial |
$5,445.32
|
| Rate for Payer: First Health Commercial |
$6,232.60
|
| Rate for Payer: Humana Commercial |
$5,576.54
|
| Rate for Payer: Humana KY Medicaid |
$2,256.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,301.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.80
|
| Rate for Payer: PHCS Commercial |
$6,298.20
|
| Rate for Payer: United Healthcare All Payer |
$5,773.35
|
|
|
COLPOPERINEORRHAPHY(T
|
Facility
|
IP
|
$6,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
761T2179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$852.88 |
| Max. Negotiated Rate |
$6,298.20 |
| Rate for Payer: Aetna Commercial |
$5,051.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,117.29
|
| Rate for Payer: Cash Price |
$3,280.32
|
| Rate for Payer: Cigna Commercial |
$5,445.32
|
| Rate for Payer: First Health Commercial |
$6,232.60
|
| Rate for Payer: Humana Commercial |
$5,576.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.80
|
| Rate for Payer: PHCS Commercial |
$6,298.20
|
| Rate for Payer: United Healthcare All Payer |
$5,773.35
|
|
|
COLPOPEXY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57280
|
| Hospital Charge Code |
76102185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
COLPOPEXY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57280
|
| Hospital Charge Code |
76102185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
COLPOPEXY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57280
|
| Hospital Charge Code |
76102185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.76 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,467.65
|
| Rate for Payer: Anthem Medicaid |
$518.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,414.69
|
| Rate for Payer: Healthspan PPO |
$1,421.06
|
| Rate for Payer: Humana Medicaid |
$518.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,245.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$529.14
|
| Rate for Payer: Molina Healthcare Passport |
$518.76
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.95
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
76102187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.84 |
| Max. Negotiated Rate |
$1,760.00 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Anthem Medicaid |
$498.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,760.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,015.34
|
| Rate for Payer: Healthspan PPO |
$1,001.08
|
| Rate for Payer: Humana Medicaid |
$498.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$898.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$508.82
|
| Rate for Payer: Molina Healthcare Passport |
$498.84
|
| Rate for Payer: Multiplan PHCS |
$1,056.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,232.00
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$503.83
|
|
