|
EXC. EXCESSIVE SKIN ABD.(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761P0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.54 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$1,726.32
|
| Rate for Payer: Anthem Medicaid |
$818.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,623.16
|
| Rate for Payer: Healthspan PPO |
$1,380.35
|
| Rate for Payer: Humana Medicaid |
$818.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,462.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$834.91
|
| Rate for Payer: Molina Healthcare Passport |
$818.54
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$826.73
|
|
|
EXC. EXCESSIVE SKIN ABD.(T
|
Facility
|
OP
|
$12,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761T0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,663.60 |
| Max. Negotiated Rate |
$12,285.08 |
| Rate for Payer: Aetna Commercial |
$9,853.66
|
| Rate for Payer: Anthem Medicaid |
$4,400.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cigna Commercial |
$10,621.48
|
| Rate for Payer: First Health Commercial |
$12,157.11
|
| Rate for Payer: Humana Commercial |
$10,877.42
|
| Rate for Payer: Humana KY Medicaid |
$4,400.87
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,445.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,489.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,597.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,967.06
|
| Rate for Payer: PHCS Commercial |
$12,285.08
|
| Rate for Payer: United Healthcare All Payer |
$11,261.32
|
|
|
EXC. EXCESSIVE SKIN ABD.(T
|
Facility
|
IP
|
$12,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761T0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,663.60 |
| Max. Negotiated Rate |
$12,285.08 |
| Rate for Payer: Aetna Commercial |
$9,853.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.63
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cigna Commercial |
$10,621.48
|
| Rate for Payer: First Health Commercial |
$12,157.11
|
| Rate for Payer: Humana Commercial |
$10,877.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,597.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,967.06
|
| Rate for Payer: PHCS Commercial |
$12,285.08
|
| Rate for Payer: United Healthcare All Payer |
$11,261.32
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Professional
|
Both
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$8,315.42 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,315.42
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$647.20
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.02
|
| Rate for Payer: Multiplan PHCS |
$4,989.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,820.79
|
| Rate for Payer: UHCCP Medicaid |
$2,910.40
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
IP
|
$6,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761T0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$821.00 |
| Max. Negotiated Rate |
$6,062.80 |
| Rate for Payer: Aetna Commercial |
$4,862.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,926.03
|
| Rate for Payer: Cash Price |
$3,157.71
|
| Rate for Payer: Cigna Commercial |
$5,241.80
|
| Rate for Payer: First Health Commercial |
$5,999.65
|
| Rate for Payer: Humana Commercial |
$5,368.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,178.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,660.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,894.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,557.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,736.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,263.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$821.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.78
|
| Rate for Payer: PHCS Commercial |
$6,062.80
|
| Rate for Payer: United Healthcare All Payer |
$5,557.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
IP
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.00 |
| Max. Negotiated Rate |
$7,982.80 |
| Rate for Payer: Aetna Commercial |
$6,402.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,486.03
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$6,901.80
|
| Rate for Payer: First Health Commercial |
$7,899.65
|
| Rate for Payer: Humana Commercial |
$7,068.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,818.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,136.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,494.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,317.57
|
| Rate for Payer: Ohio Health Group HMO |
$6,236.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,577.78
|
| Rate for Payer: PHCS Commercial |
$7,982.80
|
| Rate for Payer: United Healthcare All Payer |
$7,317.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
OP
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.00 |
| Max. Negotiated Rate |
$7,982.80 |
| Rate for Payer: Kentucky WC Medicaid |
$2,888.78
|
| Rate for Payer: Aetna Commercial |
$6,402.87
|
| Rate for Payer: Anthem Medicaid |
$2,859.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,486.03
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$6,901.80
|
| Rate for Payer: First Health Commercial |
$7,899.65
|
| Rate for Payer: Humana Commercial |
$7,068.11
|
| Rate for Payer: Humana KY Medicaid |
$2,859.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,818.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,136.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,494.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,317.57
|
| Rate for Payer: Ohio Health Group HMO |
$6,236.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,577.78
|
| Rate for Payer: PHCS Commercial |
$7,982.80
|
| Rate for Payer: United Healthcare All Payer |
$7,317.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761P0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$647.20
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.02
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
OP
|
$6,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761T0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$821.00 |
| Max. Negotiated Rate |
$6,062.80 |
| Rate for Payer: Aetna Commercial |
$4,862.87
|
| Rate for Payer: Anthem Medicaid |
$2,171.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,926.03
|
| Rate for Payer: Cash Price |
$3,157.71
|
| Rate for Payer: Cigna Commercial |
$5,241.80
|
| Rate for Payer: First Health Commercial |
$5,999.65
|
| Rate for Payer: Humana Commercial |
$5,368.11
|
| Rate for Payer: Humana KY Medicaid |
$2,171.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,193.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,178.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,660.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,894.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,215.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,557.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,736.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,263.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$821.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.78
|
| Rate for Payer: PHCS Commercial |
$6,062.80
|
| Rate for Payer: United Healthcare All Payer |
$5,557.57
|
|
|
EXC EXT HEMORRHOID TAGS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXC EXT HEMORRHOID TAGS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXC EXT HEMORRHOID TAGS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$243.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.24
|
| Rate for Payer: Anthem Medicaid |
$87.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Healthspan PPO |
$297.11
|
| Rate for Payer: Humana Medicaid |
$87.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.75
|
| Rate for Payer: Molina Healthcare Passport |
$87.99
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$113.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.87
|
|
|
EXC EXT HEMORRHOID TAGS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
761P1918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$243.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.24
|
| Rate for Payer: Anthem Medicaid |
$87.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Healthspan PPO |
$297.11
|
| Rate for Payer: Humana Medicaid |
$87.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.75
|
| Rate for Payer: Molina Healthcare Passport |
$87.99
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$113.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.87
|
|
|
EXC FACE LES SC < 2 CM
|
Facility
|
OP
|
$5,145.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$668.85 |
| Max. Negotiated Rate |
$4,939.20 |
| Rate for Payer: Aetna Commercial |
$3,961.65
|
| Rate for Payer: Anthem Medicaid |
$1,769.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.10
|
| 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 |
$2,572.50
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: Cigna Commercial |
$4,270.35
|
| Rate for Payer: First Health Commercial |
$4,887.75
|
| Rate for Payer: Humana Commercial |
$4,373.25
|
| Rate for Payer: Humana KY Medicaid |
$1,769.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,218.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,804.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,527.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,858.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,594.95
|
| Rate for Payer: PHCS Commercial |
$4,939.20
|
| Rate for Payer: United Healthcare All Payer |
$4,527.60
|
|
|
EXC FACE LES SC < 2 CM
|
Facility
|
IP
|
$5,145.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$668.85 |
| Max. Negotiated Rate |
$4,939.20 |
| Rate for Payer: Aetna Commercial |
$3,961.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.10
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: Cigna Commercial |
$4,270.35
|
| Rate for Payer: First Health Commercial |
$4,887.75
|
| Rate for Payer: Humana Commercial |
$4,373.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,218.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,527.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,858.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,594.95
|
| Rate for Payer: PHCS Commercial |
$4,939.20
|
| Rate for Payer: United Healthcare All Payer |
$4,527.60
|
|
|
EXC FACE LES SC < 2 CM
|
Professional
|
Both
|
$5,145.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.54 |
| Max. Negotiated Rate |
$5,145.00 |
| Rate for Payer: Aetna Commercial |
$372.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.54
|
| Rate for Payer: Anthem Medicaid |
$177.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,145.00
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: Cash Price |
$2,572.50
|
| Rate for Payer: Cigna Commercial |
$542.96
|
| Rate for Payer: Healthspan PPO |
$336.12
|
| Rate for Payer: Humana Medicaid |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$310.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.66
|
| Rate for Payer: Molina Healthcare Passport |
$177.12
|
| Rate for Payer: Multiplan PHCS |
$3,087.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,601.50
|
| Rate for Payer: UHCCP Medicaid |
$139.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.89
|
|
|
EXC FACE LES SC = 2 CM
|
Professional
|
Both
|
$6,007.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$6,007.00 |
| Rate for Payer: Aetna Commercial |
$512.89
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,007.00
|
| Rate for Payer: Cash Price |
$3,003.50
|
| Rate for Payer: Cash Price |
$3,003.50
|
| Rate for Payer: Cigna Commercial |
$587.11
|
| Rate for Payer: Healthspan PPO |
$365.49
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$3,604.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,204.90
|
| Rate for Payer: UHCCP Medicaid |
$2,102.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
EXC FACE LES SC = 2 CM
|
Facility
|
IP
|
$6,007.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.91 |
| Max. Negotiated Rate |
$5,766.72 |
| Rate for Payer: Aetna Commercial |
$4,625.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,685.46
|
| Rate for Payer: Cash Price |
$3,003.50
|
| Rate for Payer: Cigna Commercial |
$4,985.81
|
| Rate for Payer: First Health Commercial |
$5,706.65
|
| Rate for Payer: Humana Commercial |
$5,105.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,925.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,433.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,802.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,286.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,201.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,862.17
|
| Rate for Payer: PHCS Commercial |
$5,766.72
|
| Rate for Payer: United Healthcare All Payer |
$5,286.16
|
|
|
EXC FACE LES SC = 2 CM
|
Facility
|
OP
|
$6,007.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.91 |
| Max. Negotiated Rate |
$5,766.72 |
| Rate for Payer: Aetna Commercial |
$4,625.39
|
| Rate for Payer: Anthem Medicaid |
$2,065.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,685.46
|
| 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 |
$3,003.50
|
| Rate for Payer: Cash Price |
$3,003.50
|
| Rate for Payer: Cigna Commercial |
$4,985.81
|
| Rate for Payer: First Health Commercial |
$5,706.65
|
| Rate for Payer: Humana Commercial |
$5,105.95
|
| Rate for Payer: Humana KY Medicaid |
$2,065.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,086.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,925.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,433.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,107.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,286.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,201.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$780.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,862.17
|
| Rate for Payer: PHCS Commercial |
$5,766.72
|
| Rate for Payer: United Healthcare All Payer |
$5,286.16
|
|
|
EXC FACE LES SC < 2 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761P0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.54 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$372.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.54
|
| Rate for Payer: Anthem Medicaid |
$177.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$542.96
|
| Rate for Payer: Healthspan PPO |
$336.12
|
| Rate for Payer: Humana Medicaid |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$310.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.66
|
| Rate for Payer: Molina Healthcare Passport |
$177.12
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$139.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.89
|
|
|
EXC FACE LES SC = 2 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761P0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$512.89
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$587.11
|
| Rate for Payer: Healthspan PPO |
$365.49
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
EXC FACE LES SC < 2 CM(T
|
Facility
|
OP
|
$4,145.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761T0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.85 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem Medicaid |
$1,425.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| 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 |
$2,072.50
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Humana KY Medicaid |
$1,425.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.95
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
EXC FACE LES SC < 2 CM(T
|
Facility
|
IP
|
$4,145.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761T0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.85 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.95
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
EXC FACE LES SC = 2 CM(T
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761T0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| 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 |
$2,503.50
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
EXC FACE LES SC = 2 CM(T
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761T0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
