|
DELAY FLAP F/C/C/N/AX/G/H/F(T
|
Facility
|
IP
|
$6,376.83
|
|
|
Service Code
|
HCPCS 15620
|
| Hospital Charge Code |
761T0202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,913.05 |
| Max. Negotiated Rate |
$6,121.76 |
| Rate for Payer: Aetna Commercial |
$4,910.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,973.93
|
| Rate for Payer: Cash Price |
$3,188.42
|
| Rate for Payer: Cigna Commercial |
$5,292.77
|
| Rate for Payer: First Health Commercial |
$6,057.99
|
| Rate for Payer: Humana Commercial |
$5,420.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,913.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,611.61
|
| Rate for Payer: Ohio Health Group HMO |
$4,782.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,101.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,547.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.01
|
| Rate for Payer: PHCS Commercial |
$6,121.76
|
| Rate for Payer: United Healthcare All Payer |
$5,611.61
|
|
|
DELAY OF FLAP AT FACE
|
Facility
|
IP
|
$6,852.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,055.60 |
| Max. Negotiated Rate |
$6,577.92 |
| Rate for Payer: Aetna Commercial |
$5,276.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.56
|
| Rate for Payer: Cash Price |
$3,426.00
|
| Rate for Payer: Cigna Commercial |
$5,687.16
|
| Rate for Payer: First Health Commercial |
$6,509.40
|
| Rate for Payer: Humana Commercial |
$5,824.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,961.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.88
|
| Rate for Payer: PHCS Commercial |
$6,577.92
|
| Rate for Payer: United Healthcare All Payer |
$6,029.76
|
|
|
DELAY OF FLAP AT FACE
|
Facility
|
OP
|
$6,852.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$6,577.92 |
| Rate for Payer: Aetna Commercial |
$5,276.04
|
| Rate for Payer: Anthem Medicaid |
$2,356.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$3,426.00
|
| Rate for Payer: Cash Price |
$3,426.00
|
| Rate for Payer: Cigna Commercial |
$5,687.16
|
| Rate for Payer: First Health Commercial |
$6,509.40
|
| Rate for Payer: Humana Commercial |
$5,824.20
|
| Rate for Payer: Humana KY Medicaid |
$2,356.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,380.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,403.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,961.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,727.88
|
| Rate for Payer: PHCS Commercial |
$6,577.92
|
| Rate for Payer: United Healthcare All Payer |
$6,029.76
|
|
|
DELAY OF FLAP AT FACE
|
Professional
|
Both
|
$6,852.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.07 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Aetna Commercial |
$482.39
|
| Rate for Payer: Ambetter Exchange |
$322.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$174.07
|
| Rate for Payer: Anthem Medicaid |
$214.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.98
|
| Rate for Payer: Cash Price |
$3,426.00
|
| Rate for Payer: Cash Price |
$3,426.00
|
| Rate for Payer: Cigna Commercial |
$459.91
|
| Rate for Payer: Healthspan PPO |
$502.54
|
| Rate for Payer: Humana Medicaid |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$431.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.30
|
| Rate for Payer: Molina Healthcare Passport |
$214.02
|
| Rate for Payer: Multiplan PHCS |
$4,111.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.22
|
| Rate for Payer: UHCCP Medicaid |
$182.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.48
|
|
|
DELAY OF FLAP AT FACE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
761P0203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.07 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$482.39
|
| Rate for Payer: Ambetter Exchange |
$322.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$174.07
|
| Rate for Payer: Anthem Medicaid |
$214.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$322.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$322.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.98
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$459.91
|
| Rate for Payer: Healthspan PPO |
$502.54
|
| Rate for Payer: Humana Medicaid |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$431.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.30
|
| Rate for Payer: Molina Healthcare Passport |
$214.02
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$419.22
|
| Rate for Payer: UHCCP Medicaid |
$182.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$322.48
|
|
|
DELAY OF FLAP AT FACE(T
|
Facility
|
IP
|
$5,852.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
761T0203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,755.60 |
| Max. Negotiated Rate |
$5,617.92 |
| Rate for Payer: Aetna Commercial |
$4,506.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,564.56
|
| Rate for Payer: Cash Price |
$2,926.00
|
| Rate for Payer: Cigna Commercial |
$4,857.16
|
| Rate for Payer: First Health Commercial |
$5,559.40
|
| Rate for Payer: Humana Commercial |
$4,974.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,798.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,318.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,755.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,149.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,389.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,091.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,037.88
|
| Rate for Payer: PHCS Commercial |
$5,617.92
|
| Rate for Payer: United Healthcare All Payer |
$5,149.76
|
|
|
DELAY OF FLAP AT FACE(T
|
Facility
|
OP
|
$5,852.00
|
|
|
Service Code
|
HCPCS 15630
|
| Hospital Charge Code |
761T0203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$5,617.92 |
| Rate for Payer: Aetna Commercial |
$4,506.04
|
| Rate for Payer: Anthem Medicaid |
$2,012.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,564.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,926.00
|
| Rate for Payer: Cash Price |
$2,926.00
|
| Rate for Payer: Cigna Commercial |
$4,857.16
|
| Rate for Payer: First Health Commercial |
$5,559.40
|
| Rate for Payer: Humana Commercial |
$4,974.20
|
| Rate for Payer: Humana KY Medicaid |
$2,012.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,032.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,798.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,318.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,052.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,149.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,389.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,091.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,037.88
|
| Rate for Payer: PHCS Commercial |
$5,617.92
|
| Rate for Payer: United Healthcare All Payer |
$5,149.76
|
|
|
DELAY OF TRAM FLAP
|
Facility
|
IP
|
$7,262.34
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
76100201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,178.70 |
| Max. Negotiated Rate |
$6,971.85 |
| Rate for Payer: Aetna Commercial |
$5,592.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Cash Price |
$3,631.17
|
| Rate for Payer: Cigna Commercial |
$6,027.74
|
| Rate for Payer: First Health Commercial |
$6,899.22
|
| Rate for Payer: Humana Commercial |
$6,172.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,955.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,178.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,390.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,446.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,809.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,318.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,011.01
|
| Rate for Payer: PHCS Commercial |
$6,971.85
|
| Rate for Payer: United Healthcare All Payer |
$6,390.86
|
|
|
DELAY OF TRAM FLAP
|
Facility
|
OP
|
$7,262.34
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
76100201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,497.52 |
| Max. Negotiated Rate |
$6,971.85 |
| Rate for Payer: Aetna Commercial |
$5,592.00
|
| Rate for Payer: Anthem Medicaid |
$2,497.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,664.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,631.17
|
| Rate for Payer: Cash Price |
$3,631.17
|
| Rate for Payer: Cigna Commercial |
$6,027.74
|
| Rate for Payer: First Health Commercial |
$6,899.22
|
| Rate for Payer: Humana Commercial |
$6,172.99
|
| Rate for Payer: Humana KY Medicaid |
$2,497.52
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,522.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,955.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,359.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,547.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,390.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,446.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,809.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,318.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,011.01
|
| Rate for Payer: PHCS Commercial |
$6,971.85
|
| Rate for Payer: United Healthcare All Payer |
$6,390.86
|
|
|
DELAY OF TRAM FLAP
|
Professional
|
Both
|
$7,262.34
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
76100201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$4,357.40 |
| Rate for Payer: Aetna Commercial |
$282.72
|
| Rate for Payer: Ambetter Exchange |
$197.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.90
|
| Rate for Payer: Anthem Medicaid |
$138.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.47
|
| Rate for Payer: Cash Price |
$3,631.17
|
| Rate for Payer: Cash Price |
$3,631.17
|
| Rate for Payer: Cigna Commercial |
$282.95
|
| Rate for Payer: Healthspan PPO |
$354.88
|
| Rate for Payer: Humana Medicaid |
$138.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.36
|
| Rate for Payer: Molina Healthcare Passport |
$138.59
|
| Rate for Payer: Multiplan PHCS |
$4,357.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.18
|
| Rate for Payer: UHCCP Medicaid |
$114.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.06
|
|
|
DELAY OF TRAM FLAP(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
761P0201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.90 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$282.72
|
| Rate for Payer: Ambetter Exchange |
$197.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.90
|
| Rate for Payer: Anthem Medicaid |
$138.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.47
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$282.95
|
| Rate for Payer: Healthspan PPO |
$354.88
|
| Rate for Payer: Humana Medicaid |
$138.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.36
|
| Rate for Payer: Molina Healthcare Passport |
$138.59
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.18
|
| Rate for Payer: UHCCP Medicaid |
$114.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.06
|
|
|
DELAY OF TRAM FLAP(T
|
Facility
|
OP
|
$6,612.34
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
761T0201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,273.98 |
| Max. Negotiated Rate |
$6,347.85 |
| Rate for Payer: Aetna Commercial |
$5,091.50
|
| Rate for Payer: Anthem Medicaid |
$2,273.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,306.17
|
| Rate for Payer: Cash Price |
$3,306.17
|
| Rate for Payer: Cigna Commercial |
$5,488.24
|
| Rate for Payer: First Health Commercial |
$6,281.72
|
| Rate for Payer: Humana Commercial |
$5,620.49
|
| Rate for Payer: Humana KY Medicaid |
$2,273.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,879.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,319.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.86
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,752.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,562.51
|
| Rate for Payer: PHCS Commercial |
$6,347.85
|
| Rate for Payer: United Healthcare All Payer |
$5,818.86
|
|
|
DELAY OF TRAM FLAP(T
|
Facility
|
IP
|
$6,612.34
|
|
|
Service Code
|
HCPCS 15600
|
| Hospital Charge Code |
761T0201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,983.70 |
| Max. Negotiated Rate |
$6,347.85 |
| Rate for Payer: Aetna Commercial |
$5,091.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,157.63
|
| Rate for Payer: Cash Price |
$3,306.17
|
| Rate for Payer: Cigna Commercial |
$5,488.24
|
| Rate for Payer: First Health Commercial |
$6,281.72
|
| Rate for Payer: Humana Commercial |
$5,620.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,422.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,879.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,983.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,818.86
|
| Rate for Payer: Ohio Health Group HMO |
$4,959.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,752.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,562.51
|
| Rate for Payer: PHCS Commercial |
$6,347.85
|
| Rate for Payer: United Healthcare All Payer |
$5,818.86
|
|
|
DEL II R-T REC 9*34 LEFT
|
Facility
|
OP
|
$4,908.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.44 |
| Max. Negotiated Rate |
$4,711.80 |
| Rate for Payer: Aetna Commercial |
$3,779.25
|
| Rate for Payer: Anthem Medicaid |
$1,687.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,828.33
|
| Rate for Payer: Cash Price |
$2,454.06
|
| Rate for Payer: Cigna Commercial |
$4,073.74
|
| Rate for Payer: First Health Commercial |
$4,662.71
|
| Rate for Payer: Humana Commercial |
$4,171.90
|
| Rate for Payer: Humana KY Medicaid |
$1,687.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,705.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,622.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,319.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,681.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,270.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.60
|
| Rate for Payer: PHCS Commercial |
$4,711.80
|
| Rate for Payer: United Healthcare All Payer |
$4,319.15
|
|
|
DEL II R-T REC 9*34 LEFT
|
Facility
|
IP
|
$4,908.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.44 |
| Max. Negotiated Rate |
$4,711.80 |
| Rate for Payer: Aetna Commercial |
$3,779.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,828.33
|
| Rate for Payer: Cash Price |
$2,454.06
|
| Rate for Payer: Cigna Commercial |
$4,073.74
|
| Rate for Payer: First Health Commercial |
$4,662.71
|
| Rate for Payer: Humana Commercial |
$4,171.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,622.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,319.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,681.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,270.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.60
|
| Rate for Payer: PHCS Commercial |
$4,711.80
|
| Rate for Payer: United Healthcare All Payer |
$4,319.15
|
|
|
DELIVER PLACENTA
|
Facility
|
IP
|
$4,276.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
72000018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$4,104.96 |
| Rate for Payer: Aetna Commercial |
$3,292.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,335.28
|
| Rate for Payer: Cash Price |
$2,138.00
|
| Rate for Payer: Cigna Commercial |
$3,549.08
|
| Rate for Payer: First Health Commercial |
$4,062.20
|
| Rate for Payer: Humana Commercial |
$3,634.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,506.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,155.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,762.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,720.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,950.44
|
| Rate for Payer: PHCS Commercial |
$4,104.96
|
| Rate for Payer: United Healthcare All Payer |
$3,762.88
|
|
|
DELIVER PLACENTA
|
Facility
|
OP
|
$4,276.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
72000018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,470.52 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$3,292.52
|
| Rate for Payer: Anthem Medicaid |
$1,470.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,335.28
|
| 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 |
$2,138.00
|
| Rate for Payer: Cash Price |
$2,138.00
|
| Rate for Payer: Cigna Commercial |
$3,549.08
|
| Rate for Payer: First Health Commercial |
$4,062.20
|
| Rate for Payer: Humana Commercial |
$3,634.60
|
| Rate for Payer: Humana KY Medicaid |
$1,470.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,506.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,155.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,500.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,762.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,720.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,950.44
|
| Rate for Payer: PHCS Commercial |
$4,104.96
|
| Rate for Payer: United Healthcare All Payer |
$3,762.88
|
|
|
DELIVER PLACENTA
|
Professional
|
Both
|
$4,276.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
72000018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$2,565.60 |
| Rate for Payer: Aetna Commercial |
$154.64
|
| Rate for Payer: Ambetter Exchange |
$87.05
|
| Rate for Payer: Anthem Medicaid |
$84.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.46
|
| Rate for Payer: Cash Price |
$2,138.00
|
| Rate for Payer: Cash Price |
$2,138.00
|
| Rate for Payer: Cigna Commercial |
$143.33
|
| Rate for Payer: Healthspan PPO |
$112.24
|
| Rate for Payer: Humana Medicaid |
$84.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.34
|
| Rate for Payer: Molina Healthcare Passport |
$84.65
|
| Rate for Payer: Multiplan PHCS |
$2,565.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.17
|
| Rate for Payer: UHCCP Medicaid |
$1,496.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.05
|
|
|
DELIVER PLACENTA(P
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
720P0018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$154.64
|
| Rate for Payer: Ambetter Exchange |
$87.05
|
| Rate for Payer: Anthem Medicaid |
$84.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.46
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$143.33
|
| Rate for Payer: Healthspan PPO |
$112.24
|
| Rate for Payer: Humana Medicaid |
$84.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.34
|
| Rate for Payer: Molina Healthcare Passport |
$84.65
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.17
|
| Rate for Payer: UHCCP Medicaid |
$190.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.05
|
|
|
DELIVER PLACENTA(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
720T0018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
DELIVER PLACENTA(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
720T0018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| 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 |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
DELIVERY W/PRENATAL CARE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Ambetter Exchange |
$2,292.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,292.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,292.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,750.46
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,631.94
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,292.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,292.05
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,979.66
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,292.05
|
|
|
DELIVERY W/PRENATAL CARE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DELIVERY W/PRENATAL CARE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DELIVERY W/PRENATAL CARE(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
720P0015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Ambetter Exchange |
$2,292.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,292.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,292.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,750.46
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,631.94
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,292.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,292.05
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,979.66
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,292.05
|
|
