|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
76102187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Humana KY Medicaid |
$605.26
|
| Rate for Payer: Humana Medicare Advantage |
$6,534.54
|
| Rate for Payer: Kentucky WC Medicaid |
$611.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,841.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
76102187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
COLPOPEXY INTRAPERITONEAL(P
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
761P2187
|
|
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
|
|
|
COLPOPEXY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57280
|
| Hospital Charge Code |
761P2185
|
|
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, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$9,148.36
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,534.54 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,534.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,841.45
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
45000292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$7,054.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
76102178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.02 |
| Max. Negotiated Rate |
$6,771.84 |
| Rate for Payer: Aetna Commercial |
$5,431.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,502.12
|
| Rate for Payer: Cash Price |
$3,527.00
|
| Rate for Payer: Cigna Commercial |
$5,854.82
|
| Rate for Payer: First Health Commercial |
$6,701.30
|
| Rate for Payer: Humana Commercial |
$5,995.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,784.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,205.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,207.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,290.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,186.74
|
| Rate for Payer: PHCS Commercial |
$6,771.84
|
| Rate for Payer: United Healthcare All Payer |
$6,207.52
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$7,054.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
76102178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.02 |
| Max. Negotiated Rate |
$6,771.84 |
| Rate for Payer: Aetna Commercial |
$5,431.58
|
| Rate for Payer: Anthem Medicaid |
$2,425.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,502.12
|
| 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 |
$3,527.00
|
| Rate for Payer: Cash Price |
$3,527.00
|
| Rate for Payer: Cigna Commercial |
$5,854.82
|
| Rate for Payer: First Health Commercial |
$6,701.30
|
| Rate for Payer: Humana Commercial |
$5,995.90
|
| Rate for Payer: Humana KY Medicaid |
$2,425.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,784.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,205.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,207.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,290.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,186.74
|
| Rate for Payer: PHCS Commercial |
$6,771.84
|
| Rate for Payer: United Healthcare All Payer |
$6,207.52
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
45000292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761P2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$442.79
|
| Rate for Payer: Anthem Medicaid |
$195.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$427.10
|
| Rate for Payer: Healthspan PPO |
$428.73
|
| Rate for Payer: Humana Medicaid |
$195.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$383.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.16
|
| Rate for Payer: Molina Healthcare Passport |
$195.25
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.20
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761T2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$793.52 |
| Max. Negotiated Rate |
$5,859.84 |
| Rate for Payer: Aetna Commercial |
$4,700.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,761.12
|
| Rate for Payer: Cash Price |
$3,052.00
|
| Rate for Payer: Cigna Commercial |
$5,066.32
|
| Rate for Payer: First Health Commercial |
$5,798.80
|
| Rate for Payer: Humana Commercial |
$5,188.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,005.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,504.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,831.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,371.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,578.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,892.24
|
| Rate for Payer: PHCS Commercial |
$5,859.84
|
| Rate for Payer: United Healthcare All Payer |
$5,371.52
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Professional
|
Both
|
$7,054.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
76102178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$7,054.00 |
| Rate for Payer: Aetna Commercial |
$442.79
|
| Rate for Payer: Anthem Medicaid |
$195.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,054.00
|
| Rate for Payer: Cash Price |
$3,527.00
|
| Rate for Payer: Cash Price |
$3,527.00
|
| Rate for Payer: Cigna Commercial |
$427.10
|
| Rate for Payer: Healthspan PPO |
$428.73
|
| Rate for Payer: Humana Medicaid |
$195.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$383.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.16
|
| Rate for Payer: Molina Healthcare Passport |
$195.25
|
| Rate for Payer: Multiplan PHCS |
$4,232.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,937.80
|
| Rate for Payer: UHCCP Medicaid |
$2,468.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.20
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761T2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$793.52 |
| Max. Negotiated Rate |
$5,859.84 |
| Rate for Payer: Aetna Commercial |
$4,700.08
|
| Rate for Payer: Anthem Medicaid |
$2,099.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,761.12
|
| 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 |
$3,052.00
|
| Rate for Payer: Cash Price |
$3,052.00
|
| Rate for Payer: Cigna Commercial |
$5,066.32
|
| Rate for Payer: First Health Commercial |
$5,798.80
|
| Rate for Payer: Humana Commercial |
$5,188.40
|
| Rate for Payer: Humana KY Medicaid |
$2,099.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,120.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,005.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,504.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,141.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,371.52
|
| Rate for Payer: Ohio Health Group HMO |
$4,578.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$793.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,892.24
|
| Rate for Payer: PHCS Commercial |
$5,859.84
|
| Rate for Payer: United Healthcare All Payer |
$5,371.52
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
COLPOSCOPY,VAGINA W/CERV BX
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
76102642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$973.27 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem Medicaid |
$132.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$695.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$973.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.51
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Humana KY Medicaid |
$132.75
|
| Rate for Payer: Humana Medicare Advantage |
$695.19
|
| Rate for Payer: Kentucky WC Medicaid |
$134.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.66
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
COLPOSCOPY,VAGINA W/CERV BX
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
76102642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$370.56 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.66
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
45000291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
76102167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| 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 |
$1,789.00
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Humana KY Medicaid |
$1,230.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
76102167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,434.88 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
45000291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
76102166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,434.88 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
45000290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
45000290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
76102166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.14 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| 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 |
$1,789.00
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$2,969.74
|
| Rate for Payer: First Health Commercial |
$3,399.10
|
| Rate for Payer: Humana Commercial |
$3,041.30
|
| Rate for Payer: Humana KY Medicaid |
$1,230.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,933.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,640.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,148.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,683.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.18
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLS REV F HC GLD SRF T2/T2*20
|
Facility
|
IP
|
$12,264.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.37 |
| Max. Negotiated Rate |
$11,773.82 |
| Rate for Payer: Aetna Commercial |
$9,443.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,566.23
|
| Rate for Payer: Cash Price |
$6,132.20
|
| Rate for Payer: Cigna Commercial |
$10,179.45
|
| Rate for Payer: First Health Commercial |
$11,651.18
|
| Rate for Payer: Humana Commercial |
$10,424.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,056.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,051.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,679.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,792.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,198.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,594.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.96
|
| Rate for Payer: PHCS Commercial |
$11,773.82
|
| Rate for Payer: United Healthcare All Payer |
$10,792.67
|
|
