|
CONTROL OROPH HEMORR COMPLICAT
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 42961
|
| Hospital Charge Code |
76101715
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Kentucky WC Medicaid |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CONTROL OROPH HEMORR SURGICAL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CONTROL OROPH HEMORR SURGICAL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$375.00
|
| 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: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| 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 |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CONTROL OROPH HEMORR SURGICAL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42962
|
| Hospital Charge Code |
76101716
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$756.61 |
| Rate for Payer: Aetna Commercial |
$756.61
|
| Rate for Payer: Ambetter Exchange |
$487.76
|
| Rate for Payer: Anthem Medicaid |
$371.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$487.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$487.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$487.76
|
| 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 |
$634.09
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$487.76
|
|
|
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: Ambetter Exchange |
$487.76
|
| Rate for Payer: Anthem Medicaid |
$371.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$487.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$487.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$585.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$487.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$487.76
|
| 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 |
$634.09
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$487.76
|
|
|
CONVERSION EXT BIL DRG CATH
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.14 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$739.20
|
| Rate for Payer: Anthem Medicaid |
$330.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| 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 |
$3,260.78
|
| 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 |
$3,912.94
|
| 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 |
$768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.40
|
| 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 |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.17 |
| Max. Negotiated Rate |
$843.13 |
| Rate for Payer: Ambetter Exchange |
$182.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.69
|
| Rate for Payer: Anthem Medicaid |
$826.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$182.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.60
|
| 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 |
$826.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$182.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$843.13
|
| Rate for Payer: Molina Healthcare Passport |
$826.60
|
| Rate for Payer: Multiplan PHCS |
$576.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.82
|
| Rate for Payer: UHCCP Medicaid |
$199.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.17
|
|
|
CONVERSION EXT BIL DRG CATH
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
HCPCS 47535
|
| Hospital Charge Code |
76101959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.00 |
| 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 |
$768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$835.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.40
|
| 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 |
$182.17 |
| Max. Negotiated Rate |
$843.13 |
| Rate for Payer: Ambetter Exchange |
$182.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.69
|
| Rate for Payer: Anthem Medicaid |
$826.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$182.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$182.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$218.60
|
| 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 |
$826.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$182.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$182.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$843.13
|
| Rate for Payer: Molina Healthcare Passport |
$826.60
|
| Rate for Payer: Multiplan PHCS |
$576.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.82
|
| Rate for Payer: UHCCP Medicaid |
$199.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$834.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$182.17
|
|
|
CONVERT PERC TO URETERAL
|
Facility
|
IP
|
$3,462.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
76102050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,038.60 |
| 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 |
$2,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,011.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,388.78
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
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 |
$2,077.20 |
| Rate for Payer: Ambetter Exchange |
$177.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.10
|
| Rate for Payer: Anthem Medicaid |
$674.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.18
|
| 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 |
$674.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.12
|
| Rate for Payer: Molina Healthcare Passport |
$674.63
|
| Rate for Payer: Multiplan PHCS |
$2,077.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.94
|
| Rate for Payer: UHCCP Medicaid |
$177.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$681.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.65
|
|
|
CONVERT PERC TO URETERAL
|
Facility
|
OP
|
$3,462.00
|
|
|
Service Code
|
HCPCS 50434
|
| Hospital Charge Code |
76102050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,190.58 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$2,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,011.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,388.78
|
| 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 |
$688.12 |
| Rate for Payer: Ambetter Exchange |
$177.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.10
|
| Rate for Payer: Anthem Medicaid |
$674.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.18
|
| 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 |
$674.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$688.12
|
| Rate for Payer: Molina Healthcare Passport |
$674.63
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.94
|
| Rate for Payer: UHCCP Medicaid |
$177.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$681.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.65
|
|
|
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 |
$872.47 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| 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 |
$761.10 |
| 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 |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
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 |
$1,619.77 |
| 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 |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.80
|
| 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 |
$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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$3,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,097.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,249.90
|
| Rate for Payer: PHCS Commercial |
$4,521.60
|
| Rate for Payer: United Healthcare All Payer |
$4,144.80
|
|
|
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 |
$2,826.00 |
| Rate for Payer: Aetna Commercial |
$291.96
|
| Rate for Payer: Ambetter Exchange |
$174.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.19
|
| Rate for Payer: Anthem Medicaid |
$242.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$174.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.09
|
| 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 |
$242.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$174.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.84
|
| Rate for Payer: Molina Healthcare Passport |
$242.98
|
| Rate for Payer: Multiplan PHCS |
$2,826.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.51
|
| Rate for Payer: UHCCP Medicaid |
$127.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.24
|
|
|
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 |
$1,413.00 |
| 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 |
$3,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,097.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,249.90
|
| 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 |
$543.00 |
| Rate for Payer: Aetna Commercial |
$291.96
|
| Rate for Payer: Ambetter Exchange |
$174.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$121.19
|
| Rate for Payer: Anthem Medicaid |
$242.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$174.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.09
|
| 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 |
$242.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$174.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.84
|
| Rate for Payer: Molina Healthcare Passport |
$242.98
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$226.51
|
| Rate for Payer: UHCCP Medicaid |
$127.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.24
|
|
|
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 |
$1,141.50 |
| 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 |
$3,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,310.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,625.45
|
| 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 |
$1,308.54 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,929.85
|
| Rate for Payer: Anthem Medicaid |
$1,308.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,967.90
|
| 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 |
$1,902.50
|
| 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 |
$2,937.82
|
| 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 |
$3,525.38
|
| 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 |
$3,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,310.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,625.45
|
| 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
|
$1,826.98
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.09 |
| Max. Negotiated Rate |
$1,753.90 |
| Rate for Payer: Aetna Commercial |
$1,406.77
|
| Rate for Payer: Anthem Medicaid |
$628.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.04
|
| Rate for Payer: Cash Price |
$913.49
|
| Rate for Payer: Cigna Commercial |
$1,516.39
|
| Rate for Payer: First Health Commercial |
$1,735.63
|
| Rate for Payer: Humana Commercial |
$1,552.93
|
| Rate for Payer: Humana KY Medicaid |
$628.30
|
| Rate for Payer: Kentucky WC Medicaid |
$634.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,607.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,260.62
|
| Rate for Payer: PHCS Commercial |
$1,753.90
|
| Rate for Payer: United Healthcare All Payer |
$1,607.74
|
|
|
COOK EMER PNEUMOTHORAX 8.5*6
|
Facility
|
IP
|
$1,826.98
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.09 |
| Max. Negotiated Rate |
$1,753.90 |
| Rate for Payer: Aetna Commercial |
$1,406.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,425.04
|
| Rate for Payer: Cash Price |
$913.49
|
| Rate for Payer: Cigna Commercial |
$1,516.39
|
| Rate for Payer: First Health Commercial |
$1,735.63
|
| Rate for Payer: Humana Commercial |
$1,552.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,498.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,348.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,607.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,370.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,589.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,260.62
|
| Rate for Payer: PHCS Commercial |
$1,753.90
|
| Rate for Payer: United Healthcare All Payer |
$1,607.74
|
|
|
COOMBS TEST INDIRECT TITER EA
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
30001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
COOMBS TEST INDIRECT TITER EA
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 86886
|
| Hospital Charge Code |
30001231
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$221.66 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
