|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$6,104.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
45000292
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
COLPORRHAPHY SUTURE INJ VAGINA
|
Facility
|
IP
|
$7,054.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
76102178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,116.20 |
| 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 |
$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
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 57200
|
| Hospital Charge Code |
761P2178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$570.00 |
| 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 |
$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: 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 |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$404.90
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$311.46
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
COLPOSCOPY,VAGINA W/CERV BX
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
76102642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$381.12 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$309.66
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.93
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
COLPOSCOPY,VAGINA W/CERV BX
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS 57421
|
| Hospital Charge Code |
76102642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$1,126.37 |
| Rate for Payer: Aetna Commercial |
$305.69
|
| Rate for Payer: Anthem Medicaid |
$136.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$804.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$309.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,126.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,086.14
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cash Price |
$198.50
|
| Rate for Payer: Cigna Commercial |
$329.51
|
| Rate for Payer: First Health Commercial |
$377.15
|
| Rate for Payer: Humana Commercial |
$337.45
|
| Rate for Payer: Humana KY Medicaid |
$136.53
|
| Rate for Payer: Humana Medicare Advantage |
$804.55
|
| Rate for Payer: Kentucky WC Medicaid |
$137.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$325.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$349.36
|
| Rate for Payer: Ohio Health Group HMO |
$297.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$345.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.93
|
| Rate for Payer: PHCS Commercial |
$381.12
|
| Rate for Payer: United Healthcare All Payer |
$349.36
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
76102167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.47 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| 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 |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| 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 |
$1,073.40 |
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
45000291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,230.47 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| 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 |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Professional
|
Both
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
76102167
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.22 |
| Max. Negotiated Rate |
$2,146.80 |
| Rate for Payer: Aetna Commercial |
$645.16
|
| Rate for Payer: Ambetter Exchange |
$431.18
|
| Rate for Payer: Anthem Medicaid |
$242.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$517.42
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cash Price |
$1,789.00
|
| Rate for Payer: Cigna Commercial |
$623.98
|
| Rate for Payer: Healthspan PPO |
$624.68
|
| Rate for Payer: Humana Medicaid |
$242.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$561.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.06
|
| Rate for Payer: Molina Healthcare Passport |
$242.22
|
| Rate for Payer: Multiplan PHCS |
$2,146.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.53
|
| Rate for Payer: UHCCP Medicaid |
$1,252.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.18
|
|
|
COLPOTOMY DRAIN PELVIC ABSCESS
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57010
|
| Hospital Charge Code |
45000291
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,073.40 |
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
IP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
76102166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,073.40 |
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| Rate for Payer: PHCS Commercial |
$3,434.88
|
| Rate for Payer: United Healthcare All Payer |
$3,148.64
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
OP
|
$3,862.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
45000290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,328.14 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,973.74
|
| Rate for Payer: Anthem Medicaid |
$1,328.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.36
|
| 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 |
$1,931.00
|
| Rate for Payer: Cash Price |
$1,931.00
|
| Rate for Payer: Cigna Commercial |
$3,205.46
|
| Rate for Payer: First Health Commercial |
$3,668.90
|
| Rate for Payer: Humana Commercial |
$3,282.70
|
| Rate for Payer: Humana KY Medicaid |
$1,328.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,166.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,398.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,359.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,664.78
|
| Rate for Payer: PHCS Commercial |
$3,707.52
|
| Rate for Payer: United Healthcare All Payer |
$3,398.56
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
IP
|
$3,862.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
45000290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,158.60 |
| Max. Negotiated Rate |
$3,707.52 |
| Rate for Payer: Aetna Commercial |
$2,973.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.36
|
| Rate for Payer: Cash Price |
$1,931.00
|
| Rate for Payer: Cigna Commercial |
$3,205.46
|
| Rate for Payer: First Health Commercial |
$3,668.90
|
| Rate for Payer: Humana Commercial |
$3,282.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,166.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,398.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,359.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,664.78
|
| Rate for Payer: PHCS Commercial |
$3,707.52
|
| Rate for Payer: United Healthcare All Payer |
$3,398.56
|
|
|
COLPOTOMY WITH EXPLORATION
|
Facility
|
OP
|
$3,578.00
|
|
|
Service Code
|
HCPCS 57000
|
| Hospital Charge Code |
76102166
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.47 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,755.06
|
| Rate for Payer: Anthem Medicaid |
$1,230.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,790.84
|
| 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 |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$2,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,468.82
|
| 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
|
OP
|
$12,513.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,754.06 |
| Max. Negotiated Rate |
$12,012.98 |
| Rate for Payer: Aetna Commercial |
$9,635.41
|
| Rate for Payer: Anthem Medicaid |
$4,303.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,760.55
|
| Rate for Payer: Cash Price |
$6,256.76
|
| Rate for Payer: Cigna Commercial |
$10,386.22
|
| Rate for Payer: First Health Commercial |
$11,887.84
|
| Rate for Payer: Humana Commercial |
$10,636.49
|
| Rate for Payer: Humana KY Medicaid |
$4,303.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,347.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,261.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,234.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,754.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,389.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,011.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,385.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,010.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,886.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,634.33
|
| Rate for Payer: PHCS Commercial |
$12,012.98
|
| Rate for Payer: United Healthcare All Payer |
$11,011.90
|
|
|
COLS REV F HC GLD SRF T2/T2*20
|
Facility
|
IP
|
$12,513.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,754.06 |
| Max. Negotiated Rate |
$12,012.98 |
| Rate for Payer: Aetna Commercial |
$9,635.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,760.55
|
| Rate for Payer: Cash Price |
$6,256.76
|
| Rate for Payer: Cigna Commercial |
$10,386.22
|
| Rate for Payer: First Health Commercial |
$11,887.84
|
| Rate for Payer: Humana Commercial |
$10,636.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,261.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,234.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,754.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,011.90
|
| Rate for Payer: Ohio Health Group HMO |
$9,385.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,010.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,886.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,634.33
|
| Rate for Payer: PHCS Commercial |
$12,012.98
|
| Rate for Payer: United Healthcare All Payer |
$11,011.90
|
|
|
COLS REV F HC GLD SURF T2/2+*1
|
Facility
|
OP
|
$13,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,165.83 |
| Max. Negotiated Rate |
$13,330.66 |
| Rate for Payer: Aetna Commercial |
$10,692.30
|
| Rate for Payer: Anthem Medicaid |
$4,775.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,831.16
|
| Rate for Payer: Cash Price |
$6,943.05
|
| Rate for Payer: Cigna Commercial |
$11,525.46
|
| Rate for Payer: First Health Commercial |
$13,191.80
|
| Rate for Payer: Humana Commercial |
$11,803.18
|
| Rate for Payer: Humana KY Medicaid |
$4,775.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,824.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,386.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,247.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,165.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,871.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,219.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,414.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,108.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,080.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,581.41
|
| Rate for Payer: PHCS Commercial |
$13,330.66
|
| Rate for Payer: United Healthcare All Payer |
$12,219.77
|
|
|
COLS REV F HC GLD SURF T2/2+*1
|
Facility
|
IP
|
$13,886.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,165.83 |
| Max. Negotiated Rate |
$13,330.66 |
| Rate for Payer: Aetna Commercial |
$10,692.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,831.16
|
| Rate for Payer: Cash Price |
$6,943.05
|
| Rate for Payer: Cigna Commercial |
$11,525.46
|
| Rate for Payer: First Health Commercial |
$13,191.80
|
| Rate for Payer: Humana Commercial |
$11,803.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,386.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,247.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,165.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,219.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,414.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,108.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,080.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,581.41
|
| Rate for Payer: PHCS Commercial |
$13,330.66
|
| Rate for Payer: United Healthcare All Payer |
$12,219.77
|
|
|
COMBIVENT RESPIMAT INHALER 4GM
|
Facility
|
IP
|
$1,259.02
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
25002959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$377.71 |
| Max. Negotiated Rate |
$1,208.66 |
| Rate for Payer: Aetna Commercial |
$969.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.04
|
| Rate for Payer: Cash Price |
$629.51
|
| Rate for Payer: Cigna Commercial |
$1,044.99
|
| Rate for Payer: First Health Commercial |
$1,196.07
|
| Rate for Payer: Humana Commercial |
$1,070.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,032.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,107.94
|
| Rate for Payer: Ohio Health Group HMO |
$944.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.72
|
| Rate for Payer: PHCS Commercial |
$1,208.66
|
| Rate for Payer: United Healthcare All Payer |
$1,107.94
|
|
|
COMBIVENT RESPIMAT INHALER 4GM
|
Facility
|
OP
|
$1,259.02
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
25002959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$377.71 |
| Max. Negotiated Rate |
$1,208.66 |
| Rate for Payer: Aetna Commercial |
$969.45
|
| Rate for Payer: Anthem Medicaid |
$432.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.04
|
| Rate for Payer: Cash Price |
$629.51
|
| Rate for Payer: Cigna Commercial |
$1,044.99
|
| Rate for Payer: First Health Commercial |
$1,196.07
|
| Rate for Payer: Humana Commercial |
$1,070.17
|
| Rate for Payer: Humana KY Medicaid |
$432.98
|
| Rate for Payer: Kentucky WC Medicaid |
$437.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,032.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$441.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,107.94
|
| Rate for Payer: Ohio Health Group HMO |
$944.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.72
|
| Rate for Payer: PHCS Commercial |
$1,208.66
|
| Rate for Payer: United Healthcare All Payer |
$1,107.94
|
|
|
COMMON RAGWEED IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
COMMON RAGWEED IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
44000021
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
44000021
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
