|
EX ABSCRSS FISTULA SIN TRAC(T
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
320T0183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.06 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.22
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna Commercial |
$97.89
|
| Rate for Payer: Anthem Medicaid |
$52.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$98.54
|
| Rate for Payer: Healthspan PPO |
$91.72
|
| Rate for Payer: Humana Medicaid |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.09
|
| Rate for Payer: Molina Healthcare Passport |
$52.05
|
| Rate for Payer: Multiplan PHCS |
$457.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$533.40
|
| Rate for Payer: UHCCP Medicaid |
$266.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.57
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem Medicaid |
$262.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Humana KY Medicaid |
$262.05
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$264.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$236.22
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.93 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.91
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.93 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.91
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$1,561.00 |
| Rate for Payer: Aetna Commercial |
$177.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,561.00
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$221.62
|
| Rate for Payer: Healthspan PPO |
$215.25
|
| Rate for Payer: Humana Medicaid |
$86.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.74
|
| Rate for Payer: Molina Healthcare Passport |
$86.02
|
| Rate for Payer: Multiplan PHCS |
$936.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,092.70
|
| Rate for Payer: UHCCP Medicaid |
$82.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.88
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761P2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$177.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$86.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$221.62
|
| Rate for Payer: Healthspan PPO |
$215.25
|
| Rate for Payer: Humana Medicaid |
$86.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.74
|
| Rate for Payer: Molina Healthcare Passport |
$86.02
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$82.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.88
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(T
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761T2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem Medicaid |
$354.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Humana KY Medicaid |
$354.56
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$358.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.61
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(T
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761T2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.61
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$965.76 |
| Rate for Payer: Aetna Commercial |
$774.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.68
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$834.98
|
| Rate for Payer: First Health Commercial |
$955.70
|
| Rate for Payer: Humana Commercial |
$855.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.28
|
| Rate for Payer: Ohio Health Group HMO |
$754.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.86
|
| Rate for Payer: PHCS Commercial |
$965.76
|
| Rate for Payer: United Healthcare All Payer |
$885.28
|
|
|
EXAM OF CERVIX W/SCOPE
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.17 |
| Max. Negotiated Rate |
$1,006.00 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.30
|
| Rate for Payer: Anthem Medicaid |
$41.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,006.00
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$162.98
|
| Rate for Payer: Healthspan PPO |
$158.95
|
| Rate for Payer: Humana Medicaid |
$41.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.99
|
| Rate for Payer: Molina Healthcare Passport |
$41.17
|
| Rate for Payer: Multiplan PHCS |
$603.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.20
|
| Rate for Payer: UHCCP Medicaid |
$74.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.58
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.78 |
| Max. Negotiated Rate |
$965.76 |
| Rate for Payer: Aetna Commercial |
$774.62
|
| Rate for Payer: Anthem Medicaid |
$345.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$784.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cash Price |
$503.00
|
| Rate for Payer: Cigna Commercial |
$834.98
|
| Rate for Payer: First Health Commercial |
$955.70
|
| Rate for Payer: Humana Commercial |
$855.10
|
| Rate for Payer: Humana KY Medicaid |
$345.96
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$349.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$742.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$885.28
|
| Rate for Payer: Ohio Health Group HMO |
$754.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.86
|
| Rate for Payer: PHCS Commercial |
$965.76
|
| Rate for Payer: United Healthcare All Payer |
$885.28
|
|
|
EXAM OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761P2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.17 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.30
|
| Rate for Payer: Anthem Medicaid |
$41.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$162.98
|
| Rate for Payer: Healthspan PPO |
$158.95
|
| Rate for Payer: Humana Medicaid |
$41.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.99
|
| Rate for Payer: Molina Healthcare Passport |
$41.17
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$74.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.58
|
|
|
EXAM OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761T2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem Medicaid |
$174.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Humana KY Medicaid |
$174.01
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$175.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.86
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
EXAM OF CERVIX W/SCOPE(T
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761T2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$389.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$394.68
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Cigna Commercial |
$419.98
|
| Rate for Payer: First Health Commercial |
$480.70
|
| Rate for Payer: Humana Commercial |
$430.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$373.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$445.28
|
| Rate for Payer: Ohio Health Group HMO |
$379.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.86
|
| Rate for Payer: PHCS Commercial |
$485.76
|
| Rate for Payer: United Healthcare All Payer |
$445.28
|
|
|
EXAM OF VAGINA W/SCOPE
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.46 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.46
|
| Rate for Payer: Anthem Medicaid |
$66.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,125.00
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$172.97
|
| Rate for Payer: Healthspan PPO |
$168.86
|
| Rate for Payer: Humana Medicaid |
$66.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.71
|
| Rate for Payer: Molina Healthcare Passport |
$66.38
|
| Rate for Payer: Multiplan PHCS |
$675.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$787.50
|
| Rate for Payer: UHCCP Medicaid |
$66.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.04
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem Medicaid |
$386.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Humana KY Medicaid |
$386.89
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$390.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.75
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.25 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$866.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna Commercial |
$933.75
|
| Rate for Payer: First Health Commercial |
$1,068.75
|
| Rate for Payer: Humana Commercial |
$956.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.00
|
| Rate for Payer: Ohio Health Group HMO |
$843.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.75
|
| Rate for Payer: PHCS Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare All Payer |
$990.00
|
|
|
EXAM OF VAGINA W/SCOPE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761P2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.46 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.46
|
| Rate for Payer: Anthem Medicaid |
$66.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$172.97
|
| Rate for Payer: Healthspan PPO |
$168.86
|
| Rate for Payer: Humana Medicaid |
$66.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.71
|
| Rate for Payer: Molina Healthcare Passport |
$66.38
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$66.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.04
|
|
|
EXAM OF VAGINA W/SCOPE(T
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761T2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
EXAM OF VAGINA W/SCOPE(T
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761T2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Facility
|
OP
|
$7,389.25
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.60 |
| Max. Negotiated Rate |
$7,093.68 |
| Rate for Payer: Aetna Commercial |
$5,689.72
|
| Rate for Payer: Anthem Medicaid |
$2,541.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,694.62
|
| Rate for Payer: Cash Price |
$3,694.62
|
| Rate for Payer: Cigna Commercial |
$6,133.08
|
| Rate for Payer: First Health Commercial |
$7,019.79
|
| Rate for Payer: Humana Commercial |
$6,280.86
|
| Rate for Payer: Humana KY Medicaid |
$2,541.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.67
|
| Rate for Payer: PHCS Commercial |
$7,093.68
|
| Rate for Payer: United Healthcare All Payer |
$6,502.54
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Professional
|
Both
|
$7,389.25
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.58 |
| Max. Negotiated Rate |
$7,389.25 |
| Rate for Payer: Aetna Commercial |
$1,070.69
|
| Rate for Payer: Anthem Medicaid |
$503.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,389.25
|
| Rate for Payer: Cash Price |
$3,694.62
|
| Rate for Payer: Cash Price |
$3,694.62
|
| Rate for Payer: Cigna Commercial |
$1,219.02
|
| Rate for Payer: Healthspan PPO |
$763.51
|
| Rate for Payer: Humana Medicaid |
$503.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$883.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.65
|
| Rate for Payer: Molina Healthcare Passport |
$503.58
|
| Rate for Payer: Multiplan PHCS |
$4,433.55
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,172.48
|
| Rate for Payer: UHCCP Medicaid |
$2,586.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.62
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Facility
|
IP
|
$7,389.25
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.60 |
| Max. Negotiated Rate |
$7,093.68 |
| Rate for Payer: Aetna Commercial |
$5,689.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.62
|
| Rate for Payer: Cash Price |
$3,694.62
|
| Rate for Payer: Cigna Commercial |
$6,133.08
|
| Rate for Payer: First Health Commercial |
$7,019.79
|
| Rate for Payer: Humana Commercial |
$6,280.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.67
|
| Rate for Payer: PHCS Commercial |
$7,093.68
|
| Rate for Payer: United Healthcare All Payer |
$6,502.54
|
|
