|
CONTROL OROPH HEMORR SURGICAL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CONTROL OROPH HEMORR SURGICA(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
761P1716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$756.61 |
| Rate for Payer: Aetna Commercial |
$756.61
|
| Rate for Payer: Anthem Medicaid |
$371.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$750.30
|
| Rate for Payer: Healthspan PPO |
$638.06
|
| Rate for Payer: Humana Medicaid |
$371.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.20
|
| Rate for Payer: Molina Healthcare Passport |
$371.76
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.48
|
|
|
CONVERSION EXT BIL DRG CATH
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: Aetna Commercial |
$739.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.80
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$796.80
|
| Rate for Payer: First Health Commercial |
$912.00
|
| Rate for Payer: Humana Commercial |
$816.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$787.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$708.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$844.80
|
| Rate for Payer: Ohio Health Group HMO |
$720.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.60
|
| Rate for Payer: PHCS Commercial |
$921.60
|
| Rate for Payer: United Healthcare All Payer |
$844.80
|
|
|
CONVERSION EXT BIL DRG CATH
|
Professional
|
Both
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
761P1959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.69
|
| Rate for Payer: Anthem Medicaid |
$190.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$960.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$391.23
|
| Rate for Payer: Humana Medicaid |
$190.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.47
|
| Rate for Payer: Molina Healthcare Passport |
$190.66
|
| Rate for Payer: Multiplan PHCS |
$576.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$672.00
|
| Rate for Payer: UHCCP Medicaid |
$199.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.57
|
|
|
CONVERSION EXT BIL DRG CATH
|
Professional
|
Both
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.69 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.69
|
| Rate for Payer: Anthem Medicaid |
$190.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$960.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$391.23
|
| Rate for Payer: Humana Medicaid |
$190.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.47
|
| Rate for Payer: Molina Healthcare Passport |
$190.66
|
| Rate for Payer: Multiplan PHCS |
$576.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$672.00
|
| Rate for Payer: UHCCP Medicaid |
$199.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.57
|
|
|
CONVERSION EXT BIL DRG CATH
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$739.20
|
| Rate for Payer: Anthem Medicaid |
$330.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cigna Commercial |
$796.80
|
| Rate for Payer: First Health Commercial |
$912.00
|
| Rate for Payer: Humana Commercial |
$816.00
|
| Rate for Payer: Humana KY Medicaid |
$330.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$333.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$787.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$708.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$844.80
|
| Rate for Payer: Ohio Health Group HMO |
$720.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.60
|
| Rate for Payer: PHCS Commercial |
$921.60
|
| Rate for Payer: United Healthcare All Payer |
$844.80
|
|
|
CONVERT PERC TO URETERAL
|
Professional
|
Both
|
$3,462.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
76102050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.10 |
| Max. Negotiated Rate |
$3,462.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.10
|
| Rate for Payer: Anthem Medicaid |
$170.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,462.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$348.81
|
| Rate for Payer: Humana Medicaid |
$170.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.05
|
| Rate for Payer: Molina Healthcare Passport |
$170.64
|
| Rate for Payer: Multiplan PHCS |
$2,077.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,423.40
|
| Rate for Payer: UHCCP Medicaid |
$177.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.35
|
|
|
CONVERT PERC TO URETERAL
|
Facility
|
OP
|
$3,462.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
76102050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem Medicaid |
$1,190.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Humana KY Medicaid |
$1,190.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
CONVERT PERC TO URETERAL
|
Facility
|
IP
|
$3,462.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
76102050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
CONVERT PERC TO URETERAL (P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
761P2050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.10 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.10
|
| Rate for Payer: Anthem Medicaid |
$170.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$348.81
|
| Rate for Payer: Humana Medicaid |
$170.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.05
|
| Rate for Payer: Molina Healthcare Passport |
$170.64
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$177.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.35
|
|
|
CONVERT PERC TO URETERAL (T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
761T2050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
CONVERT PERC TO URETERAL (T
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
761T2050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Professional
|
Both
|
$4,710.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
76102197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.19 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$291.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.19
|
| Rate for Payer: Anthem Medicaid |
$144.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,710.00
|
| Rate for Payer: Cash Price |
$2,355.00
|
| Rate for Payer: Cash Price |
$2,355.00
|
| Rate for Payer: Cigna Commercial |
$533.51
|
| Rate for Payer: Healthspan PPO |
$477.03
|
| Rate for Payer: Humana Medicaid |
$144.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.73
|
| Rate for Payer: Molina Healthcare Passport |
$144.83
|
| Rate for Payer: Multiplan PHCS |
$2,826.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,297.00
|
| Rate for Payer: UHCCP Medicaid |
$127.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.28
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
IP
|
$4,710.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
76102197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$4,521.60 |
| Rate for Payer: Aetna Commercial |
$3,626.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.80
|
| Rate for Payer: Cash Price |
$2,355.00
|
| Rate for Payer: Cigna Commercial |
$3,909.30
|
| Rate for Payer: First Health Commercial |
$4,474.50
|
| Rate for Payer: Humana Commercial |
$4,003.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,862.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.10
|
| Rate for Payer: PHCS Commercial |
$4,521.60
|
| Rate for Payer: United Healthcare All Payer |
$4,144.80
|
|
|
CONZ OF CERVIX W/SCOPE LEEP
|
Facility
|
OP
|
$4,710.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
76102197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$4,521.60 |
| Rate for Payer: Aetna Commercial |
$3,626.70
|
| Rate for Payer: Anthem Medicaid |
$1,619.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.80
|
| 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 |
$2,355.00
|
| Rate for Payer: Cash Price |
$2,355.00
|
| Rate for Payer: Cigna Commercial |
$3,909.30
|
| Rate for Payer: First Health Commercial |
$4,474.50
|
| Rate for Payer: Humana Commercial |
$4,003.50
|
| Rate for Payer: Humana KY Medicaid |
$1,619.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,862.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.10
|
| Rate for Payer: PHCS Commercial |
$4,521.60
|
| Rate for Payer: United Healthcare All Payer |
$4,144.80
|
|
|
CONZ OF CERVIX W/SCOPE LEEP(P
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
761P2197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.19 |
| Max. Negotiated Rate |
$905.00 |
| Rate for Payer: Aetna Commercial |
$291.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.19
|
| Rate for Payer: Anthem Medicaid |
$144.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$905.00
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$533.51
|
| Rate for Payer: Healthspan PPO |
$477.03
|
| Rate for Payer: Humana Medicaid |
$144.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$147.73
|
| Rate for Payer: Molina Healthcare Passport |
$144.83
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$633.50
|
| Rate for Payer: UHCCP Medicaid |
$127.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.28
|
|
|
CONZ OF CERVIX W/SCOPE LEEP(T
|
Facility
|
IP
|
$3,805.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
761T2197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.65 |
| Max. Negotiated Rate |
$3,652.80 |
| Rate for Payer: Aetna Commercial |
$2,929.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,967.90
|
| Rate for Payer: Cash Price |
$1,902.50
|
| Rate for Payer: Cigna Commercial |
$3,158.15
|
| Rate for Payer: First Health Commercial |
$3,614.75
|
| Rate for Payer: Humana Commercial |
$3,234.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,120.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,808.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,348.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,853.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,179.55
|
| Rate for Payer: PHCS Commercial |
$3,652.80
|
| Rate for Payer: United Healthcare All Payer |
$3,348.40
|
|
|
CONZ OF CERVIX W/SCOPE LEEP(T
|
Facility
|
OP
|
$3,805.00
|
|
|
Service Code
|
HCPCS 57461
|
| Hospital Charge Code |
761T2197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$494.65 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,929.85
|
| Rate for Payer: Anthem Medicaid |
$1,308.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,967.90
|
| 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 |
$1,902.50
|
| Rate for Payer: Cash Price |
$1,902.50
|
| Rate for Payer: Cigna Commercial |
$3,158.15
|
| Rate for Payer: First Health Commercial |
$3,614.75
|
| Rate for Payer: Humana Commercial |
$3,234.25
|
| Rate for Payer: Humana KY Medicaid |
$1,308.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,120.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,808.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,348.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,853.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,179.55
|
| Rate for Payer: PHCS Commercial |
$3,652.80
|
| Rate for Payer: United Healthcare All Payer |
$3,348.40
|
|
|
COOK EMER PNEUMOTHORAX 8.5*6
|
Facility
|
OP
|
$1,835.38
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,761.96 |
| Rate for Payer: Aetna Commercial |
$1,413.24
|
| Rate for Payer: Anthem Medicaid |
$631.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.60
|
| Rate for Payer: Cash Price |
$917.69
|
| Rate for Payer: Cigna Commercial |
$1,523.37
|
| Rate for Payer: First Health Commercial |
$1,743.61
|
| Rate for Payer: Humana Commercial |
$1,560.07
|
| Rate for Payer: Humana KY Medicaid |
$631.19
|
| Rate for Payer: Kentucky WC Medicaid |
$637.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,505.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,615.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.97
|
| Rate for Payer: PHCS Commercial |
$1,761.96
|
| Rate for Payer: United Healthcare All Payer |
$1,615.13
|
|
|
COOK EMER PNEUMOTHORAX 8.5*6
|
Facility
|
IP
|
$1,835.38
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,761.96 |
| Rate for Payer: Aetna Commercial |
$1,413.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.60
|
| Rate for Payer: Cash Price |
$917.69
|
| Rate for Payer: Cigna Commercial |
$1,523.37
|
| Rate for Payer: First Health Commercial |
$1,743.61
|
| Rate for Payer: Humana Commercial |
$1,560.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,505.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,615.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.97
|
| Rate for Payer: PHCS Commercial |
$1,761.96
|
| Rate for Payer: United Healthcare All Payer |
$1,615.13
|
|
|
COOMBS TEST INDIRECT TITER EA
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
30001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$206.78 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Humana KY Medicaid |
$5.18
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$5.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
COOMBS TEST INDIRECT TITER EA
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
30001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$157.44 |
| Rate for Payer: Aetna Commercial |
$126.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.69
|
| Rate for Payer: Cash Price |
$82.00
|
| Rate for Payer: Cigna Commercial |
$136.12
|
| Rate for Payer: First Health Commercial |
$155.80
|
| Rate for Payer: Humana Commercial |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.32
|
| Rate for Payer: Ohio Health Group HMO |
$123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.84
|
| Rate for Payer: PHCS Commercial |
$157.44
|
| Rate for Payer: United Healthcare All Payer |
$144.32
|
|
|
COONS DILATOR 10FR
|
Facility
|
OP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem Medicaid |
$164.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Humana KY Medicaid |
$164.42
|
| Rate for Payer: Kentucky WC Medicaid |
$166.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 10FR
|
Facility
|
IP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 12FR
|
Facility
|
OP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem Medicaid |
$164.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Humana KY Medicaid |
$164.42
|
| Rate for Payer: Kentucky WC Medicaid |
$166.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
