|
DES LESIOPALAT ULVULA CRYOCHM
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 42160
|
| Hospital Charge Code |
76101675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.60 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,264.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,588.88
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
DES LESIOPALAT ULVULA CRYOCHM
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 42160
|
| Hospital Charge Code |
45000257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,173.60 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
DES MAL LES 1.1-2CM FEENL
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
76100268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem Medicaid |
$299.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Humana KY Medicaid |
$299.54
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
DES MAL LES 1.1-2CM FEENL
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
76100268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
DES MAL LES 1.1-2CM FEENL
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
76100268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$522.60 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Ambetter Exchange |
$128.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.54
|
| Rate for Payer: Anthem Medicaid |
$132.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$153.90
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$246.64
|
| Rate for Payer: Healthspan PPO |
$223.33
|
| Rate for Payer: Humana Medicaid |
$132.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.57
|
| Rate for Payer: Molina Healthcare Passport |
$132.91
|
| Rate for Payer: Multiplan PHCS |
$522.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.72
|
| Rate for Payer: UHCCP Medicaid |
$98.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.25
|
|
|
DES MAL LES 1.1-2CM FEENL(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
761P0268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$246.64 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Ambetter Exchange |
$128.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.54
|
| Rate for Payer: Anthem Medicaid |
$132.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$153.90
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$246.64
|
| Rate for Payer: Healthspan PPO |
$223.33
|
| Rate for Payer: Humana Medicaid |
$132.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.57
|
| Rate for Payer: Molina Healthcare Passport |
$132.91
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.72
|
| Rate for Payer: UHCCP Medicaid |
$98.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.25
|
|
|
DES MAL LES 1.1-2CM FEENL(T
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
761T0268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.38
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
|
DES MAL LES 1.1-2CM FEENL(T
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
761T0268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.98 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem Medicaid |
$161.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| Rate for Payer: Humana KY Medicaid |
$161.98
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$163.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
|
DES MAL LES 1.1-2CM SNHF
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna Commercial |
$180.04
|
| Rate for Payer: Ambetter Exchange |
$113.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.29
|
| Rate for Payer: Anthem Medicaid |
$114.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$136.56
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$222.55
|
| Rate for Payer: Healthspan PPO |
$203.02
|
| Rate for Payer: Humana Medicaid |
$114.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.38
|
| Rate for Payer: Molina Healthcare Passport |
$114.10
|
| Rate for Payer: Multiplan PHCS |
$408.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.94
|
| Rate for Payer: UHCCP Medicaid |
$84.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.80
|
|
|
DES MAL LES 1.1-2CM SNHF
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.30 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
DES MAL LES 1.1-2CM SNHF
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
76100262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem Medicaid |
$234.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Humana KY Medicaid |
$234.20
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$236.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
DES MAL LES 1.1-2CM SNHF(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
761P0262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$222.55 |
| Rate for Payer: Aetna Commercial |
$180.04
|
| Rate for Payer: Ambetter Exchange |
$113.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.29
|
| Rate for Payer: Anthem Medicaid |
$114.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$136.56
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$222.55
|
| Rate for Payer: Healthspan PPO |
$203.02
|
| Rate for Payer: Humana Medicaid |
$114.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$161.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.38
|
| Rate for Payer: Molina Healthcare Passport |
$114.10
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.94
|
| Rate for Payer: UHCCP Medicaid |
$84.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.80
|
|
|
DES MAL LES 1.1-2CM SNHF(T
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
761T0262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
DES MAL LES 1.1-2CM SNHF(T
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 17272
|
| Hospital Charge Code |
761T0262
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$113.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Humana KY Medicaid |
$113.83
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$114.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
DES MAL LES 2.1-3CM FEENL
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$574.80 |
| Rate for Payer: Aetna Commercial |
$255.06
|
| Rate for Payer: Ambetter Exchange |
$160.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.94
|
| Rate for Payer: Anthem Medicaid |
$163.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$160.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$192.37
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$302.29
|
| Rate for Payer: Healthspan PPO |
$270.71
|
| Rate for Payer: Humana Medicaid |
$163.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$160.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.81
|
| Rate for Payer: Molina Healthcare Passport |
$163.54
|
| Rate for Payer: Multiplan PHCS |
$574.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.40
|
| Rate for Payer: UHCCP Medicaid |
$120.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$160.31
|
|
|
DES MAL LES 2.1-3CM FEENL
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.46 |
| Max. Negotiated Rate |
$919.68 |
| Rate for Payer: Aetna Commercial |
$737.66
|
| Rate for Payer: Anthem Medicaid |
$329.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$747.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$795.14
|
| Rate for Payer: First Health Commercial |
$910.10
|
| Rate for Payer: Humana Commercial |
$814.30
|
| Rate for Payer: Humana KY Medicaid |
$329.46
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$785.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.04
|
| Rate for Payer: Ohio Health Group HMO |
$718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$766.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.02
|
| Rate for Payer: PHCS Commercial |
$919.68
|
| Rate for Payer: United Healthcare All Payer |
$843.04
|
|
|
DES MAL LES 2.1-3CM FEENL
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.40 |
| Max. Negotiated Rate |
$919.68 |
| Rate for Payer: Aetna Commercial |
$737.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$747.24
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$795.14
|
| Rate for Payer: First Health Commercial |
$910.10
|
| Rate for Payer: Humana Commercial |
$814.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$785.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.04
|
| Rate for Payer: Ohio Health Group HMO |
$718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$766.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.02
|
| Rate for Payer: PHCS Commercial |
$919.68
|
| Rate for Payer: United Healthcare All Payer |
$843.04
|
|
|
DES MAL LES 2.1-3CM FEENL(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
761P0269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$302.29 |
| Rate for Payer: Aetna Commercial |
$255.06
|
| Rate for Payer: Ambetter Exchange |
$160.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.94
|
| Rate for Payer: Anthem Medicaid |
$163.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$160.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$192.37
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$302.29
|
| Rate for Payer: Healthspan PPO |
$270.71
|
| Rate for Payer: Humana Medicaid |
$163.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$160.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.81
|
| Rate for Payer: Molina Healthcare Passport |
$163.54
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.40
|
| Rate for Payer: UHCCP Medicaid |
$120.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$160.31
|
|
|
DES MAL LES 2.1-3CM FEENL(T
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
761T0269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.51 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DES MAL LES 2.1-3CM FEENL(T
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
761T0269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
DES MAL LES 3.1-4CM
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 17284
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$787.20 |
| Rate for Payer: Aetna Commercial |
$304.38
|
| Rate for Payer: Ambetter Exchange |
$187.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.92
|
| Rate for Payer: Anthem Medicaid |
$194.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.83
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$355.62
|
| Rate for Payer: Healthspan PPO |
$315.28
|
| Rate for Payer: Humana Medicaid |
$194.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.79
|
| Rate for Payer: Molina Healthcare Passport |
$194.89
|
| Rate for Payer: Multiplan PHCS |
$787.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.57
|
| Rate for Payer: UHCCP Medicaid |
$144.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.36
|
|
|
DES MAL LES 3.1-4CM
|
Facility
|
IP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 17284
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.60 |
| Max. Negotiated Rate |
$1,259.52 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,023.36
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$1,088.96
|
| Rate for Payer: First Health Commercial |
$1,246.40
|
| Rate for Payer: Humana Commercial |
$1,115.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,154.56
|
| Rate for Payer: Ohio Health Group HMO |
$984.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,049.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.28
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
DES MAL LES 3.1-4CM
|
Facility
|
OP
|
$1,312.00
|
|
|
Service Code
|
HCPCS 17284
|
| Hospital Charge Code |
76100270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,259.52 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Anthem Medicaid |
$451.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,023.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cigna Commercial |
$1,088.96
|
| Rate for Payer: First Health Commercial |
$1,246.40
|
| Rate for Payer: Humana Commercial |
$1,115.20
|
| Rate for Payer: Humana KY Medicaid |
$451.20
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$455.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,154.56
|
| Rate for Payer: Ohio Health Group HMO |
$984.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,049.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.28
|
| Rate for Payer: PHCS Commercial |
$1,259.52
|
| Rate for Payer: United Healthcare All Payer |
$1,154.56
|
|
|
DES MAL LES 3.1-4CM(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 17284
|
| Hospital Charge Code |
761P0270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.92 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$304.38
|
| Rate for Payer: Ambetter Exchange |
$187.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.92
|
| Rate for Payer: Anthem Medicaid |
$194.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.83
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$355.62
|
| Rate for Payer: Healthspan PPO |
$315.28
|
| Rate for Payer: Humana Medicaid |
$194.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.79
|
| Rate for Payer: Molina Healthcare Passport |
$194.89
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.57
|
| Rate for Payer: UHCCP Medicaid |
$144.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.36
|
|
|
DES MAL LES 3.1-4CM(T
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS 17284
|
| Hospital Charge Code |
761T0270
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$683.52 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$590.96
|
| Rate for Payer: First Health Commercial |
$676.40
|
| Rate for Payer: Humana Commercial |
$605.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
| Rate for Payer: Ohio Health Group HMO |
$534.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
