|
DILATE URETHRA STRICTURE (T
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 53601
|
| Hospital Charge Code |
761T2782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
DILATE URETHRA STRICTURE (T
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 53601
|
| Hospital Charge Code |
761T2782
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
DILATION AND CURETTAGE
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
76102208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: UHCCP Medicaid |
$141.75
|
| Rate for Payer: Aetna Commercial |
$325.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.00
|
| Rate for Payer: Anthem Medicaid |
$157.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$318.31
|
| Rate for Payer: Healthspan PPO |
$361.06
|
| Rate for Payer: Humana Medicaid |
$157.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$282.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.08
|
| Rate for Payer: Molina Healthcare Passport |
$157.92
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.50
|
|
|
DILATION AND CURETTAGE
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
76102208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
DILATION AND CURETTAGE
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 58120
|
| Hospital Charge Code |
76102208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
DILATION OF ANAL SPHINCTER (SE
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
HCPCS 45905
|
| Hospital Charge Code |
76101907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$527.45
|
| Rate for Payer: Anthem Medicaid |
$235.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$568.55
|
| Rate for Payer: First Health Commercial |
$650.75
|
| Rate for Payer: Humana Commercial |
$582.25
|
| Rate for Payer: Humana KY Medicaid |
$235.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$237.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$561.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$505.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$602.80
|
| Rate for Payer: Ohio Health Group HMO |
$513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.35
|
| Rate for Payer: PHCS Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Payer |
$602.80
|
|
|
DILATION OF ANAL SPHINCTER (SE
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
HCPCS 45905
|
| Hospital Charge Code |
76101907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.05 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna Commercial |
$527.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$534.30
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$568.55
|
| Rate for Payer: First Health Commercial |
$650.75
|
| Rate for Payer: Humana Commercial |
$582.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$561.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$505.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$602.80
|
| Rate for Payer: Ohio Health Group HMO |
$513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.35
|
| Rate for Payer: PHCS Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Payer |
$602.80
|
|
|
DILATION OF ANAL SPHINCTER (SE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 45905
|
| Hospital Charge Code |
761P1907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$237.72
|
| Rate for Payer: Anthem Medicaid |
$66.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$685.00
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$220.85
|
| Rate for Payer: Healthspan PPO |
$200.48
|
| Rate for Payer: Humana Medicaid |
$66.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$210.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.60
|
| Rate for Payer: Molina Healthcare Passport |
$66.27
|
| Rate for Payer: Multiplan PHCS |
$411.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$479.50
|
| Rate for Payer: UHCCP Medicaid |
$239.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.93
|
|
|
DILATION OF ANAL SPHINCTER (SE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 45905
|
| Hospital Charge Code |
76101907
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$237.72
|
| Rate for Payer: Anthem Medicaid |
$66.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$685.00
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$220.85
|
| Rate for Payer: Healthspan PPO |
$200.48
|
| Rate for Payer: Humana Medicaid |
$66.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$210.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.60
|
| Rate for Payer: Molina Healthcare Passport |
$66.27
|
| Rate for Payer: Multiplan PHCS |
$411.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$479.50
|
| Rate for Payer: UHCCP Medicaid |
$239.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.93
|
|
|
DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
76102808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
DILATION OF CERVICAL CANAL
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
76102808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$73.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$31.85
|
| Rate for Payer: Anthem Medicaid |
$31.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$89.49
|
| Rate for Payer: Healthspan PPO |
$87.08
|
| Rate for Payer: Humana Medicaid |
$31.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.09
|
| Rate for Payer: Molina Healthcare Passport |
$31.46
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$33.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.77
|
|
|
DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 57800
|
| Hospital Charge Code |
76102808
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES
|
Facility
|
OP
|
$1,097.45
|
|
|
Service Code
|
CPT 43450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$783.89 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
|
|
DILATION OF ESOPHAGUS, OVER GUIDE WIRE
|
Facility
|
OP
|
$2,303.66
|
|
|
Service Code
|
CPT 43453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.47 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
|
|
DILATION OF RECTAL NARROWING
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 45910
|
| Hospital Charge Code |
76102867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$281.02 |
| Rate for Payer: Aetna Commercial |
$281.02
|
| Rate for Payer: Anthem Medicaid |
$81.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.00
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$260.72
|
| Rate for Payer: Healthspan PPO |
$236.99
|
| Rate for Payer: Humana Medicaid |
$81.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$246.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.69
|
| Rate for Payer: Molina Healthcare Passport |
$81.07
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.88
|
|
|
DILATION OF RECTAL NARROWING
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 45910
|
| Hospital Charge Code |
76102867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$73.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$73.94
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$74.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.65
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
DILATION OF RECTAL NARROWING
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 45910
|
| Hospital Charge Code |
76102867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.65
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
DILATION OF VAGINA
|
Facility
|
IP
|
$6,308.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
76102936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$820.04 |
| Max. Negotiated Rate |
$6,055.68 |
| Rate for Payer: Aetna Commercial |
$4,857.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,920.24
|
| Rate for Payer: Cash Price |
$3,154.00
|
| Rate for Payer: Cigna Commercial |
$5,235.64
|
| Rate for Payer: First Health Commercial |
$5,992.60
|
| Rate for Payer: Humana Commercial |
$5,361.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,172.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,655.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,551.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,955.48
|
| Rate for Payer: PHCS Commercial |
$6,055.68
|
| Rate for Payer: United Healthcare All Payer |
$5,551.04
|
|
|
DILATION OF VAGINA
|
Facility
|
OP
|
$6,308.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
76102936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$820.04 |
| Max. Negotiated Rate |
$6,055.68 |
| Rate for Payer: Aetna Commercial |
$4,857.16
|
| Rate for Payer: Anthem Medicaid |
$2,169.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,920.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$3,154.00
|
| Rate for Payer: Cash Price |
$3,154.00
|
| Rate for Payer: Cigna Commercial |
$5,235.64
|
| Rate for Payer: First Health Commercial |
$5,992.60
|
| Rate for Payer: Humana Commercial |
$5,361.80
|
| Rate for Payer: Humana KY Medicaid |
$2,169.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,191.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,172.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,655.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,212.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,551.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,731.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$820.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,955.48
|
| Rate for Payer: PHCS Commercial |
$6,055.68
|
| Rate for Payer: United Healthcare All Payer |
$5,551.04
|
|
|
DILATION OF VAGINA
|
Professional
|
Both
|
$6,308.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
76102936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$6,308.00 |
| Rate for Payer: Aetna Commercial |
$206.83
|
| Rate for Payer: Anthem Medicaid |
$34.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,308.00
|
| Rate for Payer: Cash Price |
$3,154.00
|
| Rate for Payer: Cash Price |
$3,154.00
|
| Rate for Payer: Cigna Commercial |
$199.81
|
| Rate for Payer: Healthspan PPO |
$200.26
|
| Rate for Payer: Humana Medicaid |
$34.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.35
|
| Rate for Payer: Molina Healthcare Passport |
$34.66
|
| Rate for Payer: Multiplan PHCS |
$3,784.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,415.60
|
| Rate for Payer: UHCCP Medicaid |
$2,207.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.01
|
|
|
DILATION OF VAGINA (P
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
761P2936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$313.00 |
| Rate for Payer: Aetna Commercial |
$206.83
|
| Rate for Payer: Anthem Medicaid |
$34.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.00
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$199.81
|
| Rate for Payer: Healthspan PPO |
$200.26
|
| Rate for Payer: Humana Medicaid |
$34.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.35
|
| Rate for Payer: Molina Healthcare Passport |
$34.66
|
| Rate for Payer: Multiplan PHCS |
$187.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.10
|
| Rate for Payer: UHCCP Medicaid |
$109.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.01
|
|
|
DILATION OF VAGINA (T
|
Facility
|
OP
|
$5,995.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
761T2936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.35 |
| Max. Negotiated Rate |
$5,755.20 |
| Rate for Payer: Aetna Commercial |
$4,616.15
|
| Rate for Payer: Anthem Medicaid |
$2,061.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,676.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$2,997.50
|
| Rate for Payer: Cash Price |
$2,997.50
|
| Rate for Payer: Cigna Commercial |
$4,975.85
|
| Rate for Payer: First Health Commercial |
$5,695.25
|
| Rate for Payer: Humana Commercial |
$5,095.75
|
| Rate for Payer: Humana KY Medicaid |
$2,061.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,082.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,915.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,424.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,103.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,275.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$779.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,858.45
|
| Rate for Payer: PHCS Commercial |
$5,755.20
|
| Rate for Payer: United Healthcare All Payer |
$5,275.60
|
|
|
DILATION OF VAGINA (T
|
Facility
|
IP
|
$5,995.00
|
|
|
Service Code
|
HCPCS 57400
|
| Hospital Charge Code |
761T2936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.35 |
| Max. Negotiated Rate |
$5,755.20 |
| Rate for Payer: Aetna Commercial |
$4,616.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,676.10
|
| Rate for Payer: Cash Price |
$2,997.50
|
| Rate for Payer: Cigna Commercial |
$4,975.85
|
| Rate for Payer: First Health Commercial |
$5,695.25
|
| Rate for Payer: Humana Commercial |
$5,095.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,915.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,424.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,798.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,275.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,496.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,199.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$779.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,858.45
|
| Rate for Payer: PHCS Commercial |
$5,755.20
|
| Rate for Payer: United Healthcare All Payer |
$5,275.60
|
|
|
DILATION OF VAGINA UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 57400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
