|
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 |
$1,420.93 |
| Rate for Payer: Aetna Commercial |
$1,420.93
|
| Rate for Payer: Ambetter Exchange |
$936.48
|
| Rate for Payer: Anthem Medicaid |
$571.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$936.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$936.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,123.78
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$936.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.48
|
| 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 |
$1,217.42
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$577.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$936.48
|
|
|
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 |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$771.08
|
| Rate for Payer: Ambetter Exchange |
$500.78
|
| Rate for Payer: Anthem Medicaid |
$421.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$500.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$600.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$500.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.78
|
| 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 |
$651.01
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$500.78
|
|
|
COLPOCLEISIS (LE FORTE)
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57120
|
| Hospital Charge Code |
76102172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| 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 |
$619.02 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| 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 |
$4,561.18
|
| 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 |
$5,473.42
|
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
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 |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$771.08
|
| Rate for Payer: Ambetter Exchange |
$500.78
|
| Rate for Payer: Anthem Medicaid |
$421.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$500.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$600.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$500.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.78
|
| 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 |
$651.01
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$500.78
|
|
|
COLPOPERINEORRHAPHY
|
Facility
|
IP
|
$7,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
76102179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,268.19 |
| 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 |
$6,048.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,577.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,216.83
|
| Rate for Payer: PHCS Commercial |
$7,258.20
|
| Rate for Payer: United Healthcare All Payer |
$6,653.35
|
|
|
COLPOPERINEORRHAPHY
|
Facility
|
OP
|
$7,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
76102179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,600.10 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,897.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$6,048.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,577.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,216.83
|
| Rate for Payer: PHCS Commercial |
$7,258.20
|
| Rate for Payer: United Healthcare All Payer |
$6,653.35
|
|
|
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 |
$4,536.38 |
| Rate for Payer: Aetna Commercial |
$551.66
|
| Rate for Payer: Ambetter Exchange |
$369.56
|
| Rate for Payer: Anthem Medicaid |
$242.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$369.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$443.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$369.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.56
|
| 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 |
$480.43
|
| Rate for Payer: UHCCP Medicaid |
$2,646.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$369.56
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$551.66
|
| Rate for Payer: Ambetter Exchange |
$369.56
|
| Rate for Payer: Anthem Medicaid |
$242.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$369.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$443.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$369.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.56
|
| 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 |
$480.43
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$369.56
|
|
|
COLPOPERINEORRHAPHY(T
|
Facility
|
IP
|
$6,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
761T2179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,968.19 |
| 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 |
$5,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,707.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,526.83
|
| Rate for Payer: PHCS Commercial |
$6,298.20
|
| Rate for Payer: United Healthcare All Payer |
$5,773.35
|
|
|
COLPOPERINEORRHAPHY(T
|
Facility
|
OP
|
$6,560.63
|
|
|
Service Code
|
HCPCS 57210
|
| Hospital Charge Code |
761T2179
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,256.20 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,117.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$5,248.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,707.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,526.83
|
| 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 |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| 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 |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| 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 |
$1,467.65 |
| Rate for Payer: Aetna Commercial |
$1,467.65
|
| Rate for Payer: Ambetter Exchange |
$914.10
|
| Rate for Payer: Anthem Medicaid |
$518.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$914.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$914.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,096.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$914.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.10
|
| 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 |
$1,188.33
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$914.10
|
|
|
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 |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Ambetter Exchange |
$661.65
|
| Rate for Payer: Anthem Medicaid |
$498.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$661.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$661.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$793.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$661.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.65
|
| 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 |
$860.14
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$503.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$661.65
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
76102187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.00 |
| 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 |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
COLPOPEXY INTRAPERITONEAL
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 57283
|
| Hospital Charge Code |
76102187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.26 |
| Max. Negotiated Rate |
$9,565.72 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,832.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,565.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,224.09
|
| 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 |
$6,832.66
|
| 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 |
$8,199.19
|
| 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 |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| 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 |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$1,033.90
|
| Rate for Payer: Ambetter Exchange |
$661.65
|
| Rate for Payer: Anthem Medicaid |
$498.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$661.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$661.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$793.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$661.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.65
|
| 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 |
$860.14
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$503.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$661.65
|
|
|
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 |
$1,467.65 |
| Rate for Payer: Aetna Commercial |
$1,467.65
|
| Rate for Payer: Ambetter Exchange |
$914.10
|
| Rate for Payer: Anthem Medicaid |
$518.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$914.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$914.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,096.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$914.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$914.10
|
| 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 |
$1,188.33
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$914.10
|
|
|
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$9,565.72
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,832.66 |
| Max. Negotiated Rate |
$9,565.72 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,832.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,565.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,224.09
|
| Rate for Payer: Humana Medicare Advantage |
$6,832.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,199.19
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
45000292
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,099.17 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,761.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,883.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,310.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,211.76
|
| Rate for Payer: PHCS Commercial |
$5,859.84
|
| Rate for Payer: United Healthcare All Payer |
$5,371.52
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$7,054.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
76102178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,425.87 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,502.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$5,643.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,136.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,867.26
|
| Rate for Payer: PHCS Commercial |
$6,771.84
|
| Rate for Payer: United Healthcare All Payer |
$6,207.52
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
OP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761T2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,099.17 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,761.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$4,883.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,310.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,211.76
|
| 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 |
$4,232.40 |
| Rate for Payer: Aetna Commercial |
$442.79
|
| Rate for Payer: Ambetter Exchange |
$311.46
|
| Rate for Payer: Anthem Medicaid |
$195.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$311.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$311.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$373.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$311.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.46
|
| 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 |
$404.90
|
| Rate for Payer: UHCCP Medicaid |
$2,468.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$311.46
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761T2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,831.20 |
| 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 |
$4,883.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,310.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,211.76
|
| Rate for Payer: PHCS Commercial |
$5,859.84
|
| Rate for Payer: United Healthcare All Payer |
$5,371.52
|
|
