|
EXC BEN LESION .6-1.0 CM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761P0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.63
|
| Rate for Payer: Anthem Medicaid |
$47.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$186.50
|
| Rate for Payer: Healthspan PPO |
$155.40
|
| Rate for Payer: Humana Medicaid |
$47.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$125.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.66
|
| Rate for Payer: Molina Healthcare Passport |
$47.71
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.19
|
|
|
EXC BEN LESION .6-1.0 CM(T
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761T0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$1,539.84 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem Medicaid |
$551.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Humana KY Medicaid |
$551.62
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$557.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$562.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
EXC BEN LESION .6-1.0 CM(T
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
761T0052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$1,539.84 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Professional
|
Both
|
$5,319.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.43 |
| Max. Negotiated Rate |
$5,319.00 |
| Rate for Payer: Aetna Commercial |
$388.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.43
|
| Rate for Payer: Anthem Medicaid |
$165.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,319.00
|
| Rate for Payer: Cash Price |
$2,659.50
|
| Rate for Payer: Cash Price |
$2,659.50
|
| Rate for Payer: Cigna Commercial |
$358.36
|
| Rate for Payer: Healthspan PPO |
$365.17
|
| Rate for Payer: Humana Medicaid |
$165.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Molina Healthcare Passport |
$165.58
|
| Rate for Payer: Multiplan PHCS |
$3,191.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,723.30
|
| Rate for Payer: UHCCP Medicaid |
$145.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.24
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Facility
|
OP
|
$5,319.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.47 |
| Max. Negotiated Rate |
$5,106.24 |
| Rate for Payer: Aetna Commercial |
$4,095.63
|
| Rate for Payer: Anthem Medicaid |
$1,829.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.82
|
| 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 |
$2,659.50
|
| Rate for Payer: Cash Price |
$2,659.50
|
| Rate for Payer: Cigna Commercial |
$4,414.77
|
| Rate for Payer: First Health Commercial |
$5,053.05
|
| Rate for Payer: Humana Commercial |
$4,521.15
|
| Rate for Payer: Humana KY Medicaid |
$1,829.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,847.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,865.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.89
|
| Rate for Payer: PHCS Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare All Payer |
$4,680.72
|
|
|
EXC BEN LESION OVER 4.0 CM
|
Facility
|
IP
|
$5,319.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.47 |
| Max. Negotiated Rate |
$5,106.24 |
| Rate for Payer: Aetna Commercial |
$4,095.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.82
|
| Rate for Payer: Cash Price |
$2,659.50
|
| Rate for Payer: Cigna Commercial |
$4,414.77
|
| Rate for Payer: First Health Commercial |
$5,053.05
|
| Rate for Payer: Humana Commercial |
$4,521.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,989.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.89
|
| Rate for Payer: PHCS Commercial |
$5,106.24
|
| Rate for Payer: United Healthcare All Payer |
$4,680.72
|
|
|
EXC BEN LESION OVER 4.0 CM(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761P0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.43 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$388.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$138.43
|
| Rate for Payer: Anthem Medicaid |
$165.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$358.36
|
| Rate for Payer: Healthspan PPO |
$365.17
|
| Rate for Payer: Humana Medicaid |
$165.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.89
|
| Rate for Payer: Molina Healthcare Passport |
$165.58
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$145.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.24
|
|
|
EXC BEN LESION OVER 4.0 CM(T
|
Facility
|
OP
|
$4,519.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761T0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$587.47 |
| Max. Negotiated Rate |
$4,338.24 |
| Rate for Payer: Aetna Commercial |
$3,479.63
|
| Rate for Payer: Anthem Medicaid |
$1,554.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,524.82
|
| 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 |
$2,259.50
|
| Rate for Payer: Cash Price |
$2,259.50
|
| Rate for Payer: Cigna Commercial |
$3,750.77
|
| Rate for Payer: First Health Commercial |
$4,293.05
|
| Rate for Payer: Humana Commercial |
$3,841.15
|
| Rate for Payer: Humana KY Medicaid |
$1,554.08
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,569.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,705.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,335.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,585.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,976.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,389.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.89
|
| Rate for Payer: PHCS Commercial |
$4,338.24
|
| Rate for Payer: United Healthcare All Payer |
$3,976.72
|
|
|
EXC BEN LESION OVER 4.0 CM(T
|
Facility
|
IP
|
$4,519.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
761T0062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$587.47 |
| Max. Negotiated Rate |
$4,338.24 |
| Rate for Payer: Aetna Commercial |
$3,479.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,524.82
|
| Rate for Payer: Cash Price |
$2,259.50
|
| Rate for Payer: Cigna Commercial |
$3,750.77
|
| Rate for Payer: First Health Commercial |
$4,293.05
|
| Rate for Payer: Humana Commercial |
$3,841.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,705.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,335.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,355.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,976.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,389.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.89
|
| Rate for Payer: PHCS Commercial |
$4,338.24
|
| Rate for Payer: United Healthcare All Payer |
$3,976.72
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
761P0059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$186.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$65.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Healthspan PPO |
$186.70
|
| Rate for Payer: Humana Medicaid |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.51
|
| Rate for Payer: Molina Healthcare Passport |
$65.21
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.86
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
761T0059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
45000032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$186.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$68.70
|
| Rate for Payer: Anthem Medicaid |
$65.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$222.72
|
| Rate for Payer: Healthspan PPO |
$186.70
|
| Rate for Payer: Humana Medicaid |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$164.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.51
|
| Rate for Payer: Molina Healthcare Passport |
$65.21
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$72.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.86
|
|
|
EXC BGN LES 1.1-2.0CM S N H FG
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
761T0059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
45000030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
761T0051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.68 |
| Max. Negotiated Rate |
$1,090.56 |
| Rate for Payer: Aetna Commercial |
$874.72
|
| Rate for Payer: Anthem Medicaid |
$390.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$942.88
|
| Rate for Payer: First Health Commercial |
$1,079.20
|
| Rate for Payer: Humana Commercial |
$965.60
|
| Rate for Payer: Humana KY Medicaid |
$390.67
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$394.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$999.68
|
| Rate for Payer: Ohio Health Group HMO |
$852.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.16
|
| Rate for Payer: PHCS Commercial |
$1,090.56
|
| Rate for Payer: United Healthcare All Payer |
$999.68
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
761P0051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$104.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.22
|
| Rate for Payer: Anthem Medicaid |
$33.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$157.54
|
| Rate for Payer: Healthspan PPO |
$125.31
|
| Rate for Payer: Humana Medicaid |
$33.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.23
|
| Rate for Payer: Molina Healthcare Passport |
$33.56
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$49.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.90
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.56 |
| Max. Negotiated Rate |
$1,136.00 |
| Rate for Payer: Aetna Commercial |
$104.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.22
|
| Rate for Payer: Anthem Medicaid |
$33.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,136.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$157.54
|
| Rate for Payer: Healthspan PPO |
$125.31
|
| Rate for Payer: Humana Medicaid |
$33.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.23
|
| Rate for Payer: Molina Healthcare Passport |
$33.56
|
| Rate for Payer: Multiplan PHCS |
$681.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.20
|
| Rate for Payer: UHCCP Medicaid |
$49.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.90
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
45000030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
761T0051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXC BGNLES TRNKARMEG 0 05CMOR<
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.68 |
| Max. Negotiated Rate |
$1,090.56 |
| Rate for Payer: Aetna Commercial |
$874.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.08
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$942.88
|
| Rate for Payer: First Health Commercial |
$1,079.20
|
| Rate for Payer: Humana Commercial |
$965.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$999.68
|
| Rate for Payer: Ohio Health Group HMO |
$852.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.16
|
| Rate for Payer: PHCS Commercial |
$1,090.56
|
| Rate for Payer: United Healthcare All Payer |
$999.68
|
|
