|
EXCHANGE NEPHROSTOMY CATH(T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
761T2051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.94
|
| Rate for Payer: Anthem Medicaid |
$121.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$246.96
|
| Rate for Payer: Humana Medicaid |
$121.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.50
|
| Rate for Payer: Molina Healthcare Passport |
$121.08
|
| Rate for Payer: Multiplan PHCS |
$415.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.40
|
| Rate for Payer: UHCCP Medicaid |
$125.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.29
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$532.84
|
| Rate for Payer: Anthem Medicaid |
$237.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$574.36
|
| Rate for Payer: First Health Commercial |
$657.40
|
| Rate for Payer: Humana Commercial |
$588.20
|
| Rate for Payer: Humana KY Medicaid |
$237.98
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$240.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
| Rate for Payer: Ohio Health Group HMO |
$519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.52
|
| Rate for Payer: PHCS Commercial |
$664.32
|
| Rate for Payer: United Healthcare All Payer |
$608.96
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$664.32 |
| Rate for Payer: Aetna Commercial |
$532.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$574.36
|
| Rate for Payer: First Health Commercial |
$657.40
|
| Rate for Payer: Humana Commercial |
$588.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
| Rate for Payer: Ohio Health Group HMO |
$519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.52
|
| Rate for Payer: PHCS Commercial |
$664.32
|
| Rate for Payer: United Healthcare All Payer |
$608.96
|
|
|
EXCHANGE OF HIP HARDWARE
|
Professional
|
Both
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$7,831.35 |
| Rate for Payer: Buckeye Medicare Advantage |
$7,831.35
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$4,698.81
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,481.94
|
| Rate for Payer: UHCCP Medicaid |
$2,740.97
|
|
|
EXCHANGE OF HIP HARDWARE
|
Facility
|
IP
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.08 |
| Max. Negotiated Rate |
$7,518.10 |
| Rate for Payer: Aetna Commercial |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,108.45
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cigna Commercial |
$6,500.02
|
| Rate for Payer: First Health Commercial |
$7,439.78
|
| Rate for Payer: Humana Commercial |
$6,656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,421.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,779.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,891.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,873.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.72
|
| Rate for Payer: PHCS Commercial |
$7,518.10
|
| Rate for Payer: United Healthcare All Payer |
$6,891.59
|
|
|
EXCHANGE OF HIP HARDWARE
|
Facility
|
OP
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$7,518.10 |
| Rate for Payer: Aetna Commercial |
$6,030.14
|
| Rate for Payer: Anthem Medicaid |
$2,693.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,108.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cigna Commercial |
$6,500.02
|
| Rate for Payer: First Health Commercial |
$7,439.78
|
| Rate for Payer: Humana Commercial |
$6,656.65
|
| Rate for Payer: Humana KY Medicaid |
$2,693.20
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,720.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,421.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,779.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,747.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,891.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,873.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.72
|
| Rate for Payer: PHCS Commercial |
$7,518.10
|
| Rate for Payer: United Healthcare All Payer |
$6,891.59
|
|
|
EXCHANGE OF HIP HARDWARE(P
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761P0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
|
EXCHANGE OF HIP HARDWARE(T
|
Facility
|
OP
|
$5,681.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761T0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$5,454.10 |
| Rate for Payer: Aetna Commercial |
$4,374.64
|
| Rate for Payer: Anthem Medicaid |
$1,953.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,431.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cigna Commercial |
$4,715.52
|
| Rate for Payer: First Health Commercial |
$5,397.28
|
| Rate for Payer: Humana Commercial |
$4,829.15
|
| Rate for Payer: Humana KY Medicaid |
$1,953.82
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,973.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,658.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,192.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,999.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.22
|
| Rate for Payer: PHCS Commercial |
$5,454.10
|
| Rate for Payer: United Healthcare All Payer |
$4,999.59
|
|
|
EXCHANGE OF HIP HARDWARE(T
|
Facility
|
IP
|
$5,681.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761T0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$738.58 |
| Max. Negotiated Rate |
$5,454.10 |
| Rate for Payer: Aetna Commercial |
$4,374.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,431.45
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cigna Commercial |
$4,715.52
|
| Rate for Payer: First Health Commercial |
$5,397.28
|
| Rate for Payer: Humana Commercial |
$4,829.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,658.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,192.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,999.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.22
|
| Rate for Payer: PHCS Commercial |
$5,454.10
|
| Rate for Payer: United Healthcare All Payer |
$4,999.59
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761P0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$317.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.15
|
| Rate for Payer: Anthem Medicaid |
$142.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$290.86
|
| Rate for Payer: Healthspan PPO |
$376.40
|
| Rate for Payer: Humana Medicaid |
$142.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.49
|
| Rate for Payer: Molina Healthcare Passport |
$142.64
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$137.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.07
|
|
|
EXC HDRDNTS INGU SMPL/INT RPR
|
Facility
|
OP
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.29 |
| Max. Negotiated Rate |
$6,271.68 |
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem Medicaid |
$2,246.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| 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 |
$3,266.50
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Humana KY Medicaid |
$2,246.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,269.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,291.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.23
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
|
|
EXC HDRDNTS INGU SMPL/INT RPR
|
Facility
|
IP
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.29 |
| Max. Negotiated Rate |
$6,271.68 |
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,959.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.23
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
|
|
EXC HDRDNTS INGU SMPL/INT RPR
|
Professional
|
Both
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$6,533.00 |
| Rate for Payer: Aetna Commercial |
$317.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.15
|
| Rate for Payer: Anthem Medicaid |
$142.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,533.00
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$290.86
|
| Rate for Payer: Healthspan PPO |
$376.40
|
| Rate for Payer: Humana Medicaid |
$142.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.49
|
| Rate for Payer: Molina Healthcare Passport |
$142.64
|
| Rate for Payer: Multiplan PHCS |
$3,919.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,573.10
|
| Rate for Payer: UHCCP Medicaid |
$137.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.07
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(T
|
Facility
|
OP
|
$5,673.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761T0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$737.49 |
| Max. Negotiated Rate |
$5,446.08 |
| Rate for Payer: Aetna Commercial |
$4,368.21
|
| Rate for Payer: Anthem Medicaid |
$1,950.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.94
|
| 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 |
$2,836.50
|
| Rate for Payer: Cash Price |
$2,836.50
|
| Rate for Payer: Cigna Commercial |
$4,708.59
|
| Rate for Payer: First Health Commercial |
$5,389.35
|
| Rate for Payer: Humana Commercial |
$4,822.05
|
| Rate for Payer: Humana KY Medicaid |
$1,950.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,970.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,186.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,990.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,992.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,758.63
|
| Rate for Payer: PHCS Commercial |
$5,446.08
|
| Rate for Payer: United Healthcare All Payer |
$4,992.24
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(T
|
Facility
|
IP
|
$5,673.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761T0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$737.49 |
| Max. Negotiated Rate |
$5,446.08 |
| Rate for Payer: Aetna Commercial |
$4,368.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.94
|
| Rate for Payer: Cash Price |
$2,836.50
|
| Rate for Payer: Cigna Commercial |
$4,708.59
|
| Rate for Payer: First Health Commercial |
$5,389.35
|
| Rate for Payer: Humana Commercial |
$4,822.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,186.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,992.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,134.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,758.63
|
| Rate for Payer: PHCS Commercial |
$5,446.08
|
| Rate for Payer: United Healthcare All Payer |
$4,992.24
|
|
|
EXC HEMRHD TAG
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$161.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.98
|
| Rate for Payer: Anthem Medicaid |
$64.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$229.14
|
| Rate for Payer: Healthspan PPO |
$214.41
|
| Rate for Payer: Humana Medicaid |
$64.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.40
|
| Rate for Payer: Molina Healthcare Passport |
$64.12
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$68.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.76
|
|
|
EXC HEMRHD TAG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXC HEMRHD TAG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXC HEMRHD TAG(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
761P1916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$161.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.98
|
| Rate for Payer: Anthem Medicaid |
$64.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$229.14
|
| Rate for Payer: Healthspan PPO |
$214.41
|
| Rate for Payer: Humana Medicaid |
$64.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.40
|
| Rate for Payer: Molina Healthcare Passport |
$64.12
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$68.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.76
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
OP
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$920.54 |
| Max. Negotiated Rate |
$6,797.84 |
| Rate for Payer: Aetna Commercial |
$5,452.43
|
| Rate for Payer: Anthem Medicaid |
$2,435.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.24
|
| 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 |
$3,540.54
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$5,877.30
|
| Rate for Payer: First Health Commercial |
$6,727.03
|
| Rate for Payer: Humana Commercial |
$6,018.92
|
| Rate for Payer: Humana KY Medicaid |
$2,435.18
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,459.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.13
|
| Rate for Payer: PHCS Commercial |
$6,797.84
|
| Rate for Payer: United Healthcare All Payer |
$6,231.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
IP
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$920.54 |
| Max. Negotiated Rate |
$6,797.84 |
| Rate for Payer: Aetna Commercial |
$5,452.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.24
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$5,877.30
|
| Rate for Payer: First Health Commercial |
$6,727.03
|
| Rate for Payer: Humana Commercial |
$6,018.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.13
|
| Rate for Payer: PHCS Commercial |
$6,797.84
|
| Rate for Payer: United Healthcare All Payer |
$6,231.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
761P0072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.13 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.13
|
| Rate for Payer: Anthem Medicaid |
$173.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$413.66
|
| Rate for Payer: Healthspan PPO |
$516.54
|
| Rate for Payer: Humana Medicaid |
$173.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.88
|
| Rate for Payer: Molina Healthcare Passport |
$173.41
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$179.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.14
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
IP
|
$6,031.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
761T0072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.04 |
| Max. Negotiated Rate |
$5,789.84 |
| Rate for Payer: Aetna Commercial |
$4,643.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,704.24
|
| Rate for Payer: Cash Price |
$3,015.54
|
| Rate for Payer: Cigna Commercial |
$5,005.80
|
| Rate for Payer: First Health Commercial |
$5,729.53
|
| Rate for Payer: Humana Commercial |
$5,126.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,945.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,307.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,523.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,206.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$784.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.63
|
| Rate for Payer: PHCS Commercial |
$5,789.84
|
| Rate for Payer: United Healthcare All Payer |
$5,307.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Professional
|
Both
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.13 |
| Max. Negotiated Rate |
$7,081.08 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.13
|
| Rate for Payer: Anthem Medicaid |
$173.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,081.08
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$413.66
|
| Rate for Payer: Healthspan PPO |
$516.54
|
| Rate for Payer: Humana Medicaid |
$173.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.88
|
| Rate for Payer: Molina Healthcare Passport |
$173.41
|
| Rate for Payer: Multiplan PHCS |
$4,248.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,956.76
|
| Rate for Payer: UHCCP Medicaid |
$179.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.14
|
|
