|
EXC - OTHER BENIGN INCL MARGI
|
Facility
|
IP
|
$3,046.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
76100065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.98 |
| Max. Negotiated Rate |
$2,924.16 |
| Rate for Payer: Aetna Commercial |
$2,345.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,375.88
|
| Rate for Payer: Cash Price |
$1,523.00
|
| Rate for Payer: Cigna Commercial |
$2,528.18
|
| Rate for Payer: First Health Commercial |
$2,893.70
|
| Rate for Payer: Humana Commercial |
$2,589.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,497.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,247.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,680.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,284.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$944.26
|
| Rate for Payer: PHCS Commercial |
$2,924.16
|
| Rate for Payer: United Healthcare All Payer |
$2,680.48
|
|
|
EXC - OTHER BENIGN INCL MARG(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
761P0065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$200.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.23
|
| Rate for Payer: Anthem Medicaid |
$71.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$242.33
|
| Rate for Payer: Healthspan PPO |
$201.13
|
| Rate for Payer: Humana Medicaid |
$71.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.52
|
| Rate for Payer: Molina Healthcare Passport |
$71.10
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$77.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.81
|
|
|
EXC - OTHER BENIGN INCL MARG(T
|
Facility
|
OP
|
$2,346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
761T0065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.98 |
| Max. Negotiated Rate |
$2,252.16 |
| Rate for Payer: Aetna Commercial |
$1,806.42
|
| Rate for Payer: Anthem Medicaid |
$806.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,947.18
|
| Rate for Payer: First Health Commercial |
$2,228.70
|
| Rate for Payer: Humana Commercial |
$1,994.10
|
| Rate for Payer: Humana KY Medicaid |
$806.79
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$815.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,923.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,731.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$822.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,064.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,759.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.26
|
| Rate for Payer: PHCS Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare All Payer |
$2,064.48
|
|
|
EXC - OTHER BENIGN INCL MARG(T
|
Facility
|
IP
|
$2,346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
761T0065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.98 |
| Max. Negotiated Rate |
$2,252.16 |
| Rate for Payer: Aetna Commercial |
$1,806.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.88
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$1,947.18
|
| Rate for Payer: First Health Commercial |
$2,228.70
|
| Rate for Payer: Humana Commercial |
$1,994.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,923.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,731.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,064.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,759.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.26
|
| Rate for Payer: PHCS Commercial |
$2,252.16
|
| Rate for Payer: United Healthcare All Payer |
$2,064.48
|
|
|
EXC PAROTID TUMOR
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
76101690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
EXC PAROTID TUMOR
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
76101690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,891.26
|
| Rate for Payer: Anthem Medicaid |
$989.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,881.45
|
| Rate for Payer: Healthspan PPO |
$1,594.93
|
| Rate for Payer: Humana Medicaid |
$989.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,656.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,009.40
|
| Rate for Payer: Molina Healthcare Passport |
$989.61
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$999.51
|
|
|
EXC PAROTID TUMOR
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
76101690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
EXC PAROTID TUMOR(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 42420
|
| Hospital Charge Code |
761P1690
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$1,891.26
|
| Rate for Payer: Anthem Medicaid |
$989.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,881.45
|
| Rate for Payer: Healthspan PPO |
$1,594.93
|
| Rate for Payer: Humana Medicaid |
$989.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,656.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,009.40
|
| Rate for Payer: Molina Healthcare Passport |
$989.61
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$999.51
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$7,714.50
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
761T0106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.88 |
| Max. Negotiated Rate |
$7,405.92 |
| Rate for Payer: Aetna Commercial |
$5,940.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,017.31
|
| Rate for Payer: Cash Price |
$3,857.25
|
| Rate for Payer: Cigna Commercial |
$6,403.04
|
| Rate for Payer: First Health Commercial |
$7,328.78
|
| Rate for Payer: Humana Commercial |
$6,557.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,693.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.50
|
| Rate for Payer: PHCS Commercial |
$7,405.92
|
| Rate for Payer: United Healthcare All Payer |
$6,788.76
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$8,814.50
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
76100106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.88 |
| Max. Negotiated Rate |
$8,461.92 |
| Rate for Payer: Aetna Commercial |
$6,787.16
|
| Rate for Payer: Anthem Medicaid |
$3,031.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.31
|
| 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 |
$4,407.25
|
| Rate for Payer: Cash Price |
$4,407.25
|
| Rate for Payer: Cigna Commercial |
$7,316.04
|
| Rate for Payer: First Health Commercial |
$8,373.78
|
| Rate for Payer: Humana Commercial |
$7,492.32
|
| Rate for Payer: Humana KY Medicaid |
$3,031.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,227.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,756.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,610.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,762.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,732.50
|
| Rate for Payer: PHCS Commercial |
$8,461.92
|
| Rate for Payer: United Healthcare All Payer |
$7,756.76
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$8,814.50
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
76100106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$8,814.50 |
| Rate for Payer: Aetna Commercial |
$772.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$300.04
|
| Rate for Payer: Anthem Medicaid |
$340.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,814.50
|
| Rate for Payer: Cash Price |
$4,407.25
|
| Rate for Payer: Cash Price |
$4,407.25
|
| Rate for Payer: Cigna Commercial |
$719.83
|
| Rate for Payer: Healthspan PPO |
$720.33
|
| Rate for Payer: Humana Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.26
|
| Rate for Payer: Molina Healthcare Passport |
$340.45
|
| Rate for Payer: Multiplan PHCS |
$5,288.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,170.15
|
| Rate for Payer: UHCCP Medicaid |
$315.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.85
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Facility
|
IP
|
$8,814.50
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
76100106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.88 |
| Max. Negotiated Rate |
$8,461.92 |
| Rate for Payer: Aetna Commercial |
$6,787.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.31
|
| Rate for Payer: Cash Price |
$4,407.25
|
| Rate for Payer: Cigna Commercial |
$7,316.04
|
| Rate for Payer: First Health Commercial |
$8,373.78
|
| Rate for Payer: Humana Commercial |
$7,492.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,227.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,756.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,610.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,762.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,732.50
|
| Rate for Payer: PHCS Commercial |
$8,461.92
|
| Rate for Payer: United Healthcare All Payer |
$7,756.76
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
761P0106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.04 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$772.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$300.04
|
| Rate for Payer: Anthem Medicaid |
$340.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$719.83
|
| Rate for Payer: Healthspan PPO |
$720.33
|
| Rate for Payer: Humana Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$347.26
|
| Rate for Payer: Molina Healthcare Passport |
$340.45
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$315.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.85
|
|
|
EXC PILONIDAL CYST COMPLICATED
|
Facility
|
OP
|
$7,714.50
|
|
|
Service Code
|
HCPCS 11772
|
| Hospital Charge Code |
761T0106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,002.88 |
| Max. Negotiated Rate |
$7,405.92 |
| Rate for Payer: Aetna Commercial |
$5,940.16
|
| Rate for Payer: Anthem Medicaid |
$2,653.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,017.31
|
| 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 |
$3,857.25
|
| Rate for Payer: Cash Price |
$3,857.25
|
| Rate for Payer: Cigna Commercial |
$6,403.04
|
| Rate for Payer: First Health Commercial |
$7,328.78
|
| Rate for Payer: Humana Commercial |
$6,557.32
|
| Rate for Payer: Humana KY Medicaid |
$2,653.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,680.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,325.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,693.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,706.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,788.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,785.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.50
|
| Rate for Payer: PHCS Commercial |
$7,405.92
|
| Rate for Payer: United Healthcare All Payer |
$6,788.76
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
76101879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.70
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
EXC RECT TUM TRANSANAL PART
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
76101879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem Medicaid |
$539.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| 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 |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Humana KY Medicaid |
$539.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$545.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.70
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
EXC RECT TUM TRANSANAL PART
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
76101879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.31 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Aetna Commercial |
$911.27
|
| Rate for Payer: Anthem Medicaid |
$430.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,570.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: Healthspan PPO |
$604.60
|
| Rate for Payer: Humana Medicaid |
$430.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$438.92
|
| Rate for Payer: Molina Healthcare Passport |
$430.31
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,099.00
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.61
|
|
|
EXC RECT TUM TRANSANAL PART(P
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
761P1879
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$430.31 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Aetna Commercial |
$911.27
|
| Rate for Payer: Anthem Medicaid |
$430.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,570.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$920.55
|
| Rate for Payer: Healthspan PPO |
$604.60
|
| Rate for Payer: Humana Medicaid |
$430.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$438.92
|
| Rate for Payer: Molina Healthcare Passport |
$430.31
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,099.00
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$434.61
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 15936
|
| Hospital Charge Code |
761T0234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Anthem Medicaid |
$1,547.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,510.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$3,735.00
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Humana Commercial |
$3,825.00
|
| Rate for Payer: Humana KY Medicaid |
$1,547.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,690.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,321.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,960.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.00
|
| Rate for Payer: PHCS Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Payer |
$3,960.00
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
OP
|
$6,146.49
|
|
|
Service Code
|
HCPCS 15937
|
| Hospital Charge Code |
76100235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.04 |
| Max. Negotiated Rate |
$5,900.63 |
| Rate for Payer: Aetna Commercial |
$4,732.80
|
| Rate for Payer: Anthem Medicaid |
$2,113.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,794.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,073.24
|
| Rate for Payer: Cash Price |
$3,073.24
|
| Rate for Payer: Cigna Commercial |
$5,101.59
|
| Rate for Payer: First Health Commercial |
$5,839.17
|
| Rate for Payer: Humana Commercial |
$5,224.52
|
| Rate for Payer: Humana KY Medicaid |
$2,113.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,135.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,040.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,536.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,156.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,408.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,609.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,229.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$799.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,905.41
|
| Rate for Payer: PHCS Commercial |
$5,900.63
|
| Rate for Payer: United Healthcare All Payer |
$5,408.91
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 15937
|
| Hospital Charge Code |
761P0235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$1,506.75 |
| Rate for Payer: Aetna Commercial |
$1,506.75
|
| Rate for Payer: Anthem Medicaid |
$807.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,235.00
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,445.88
|
| Rate for Payer: Healthspan PPO |
$1,204.79
|
| Rate for Payer: Humana Medicaid |
$807.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,303.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$823.19
|
| Rate for Payer: Molina Healthcare Passport |
$807.05
|
| Rate for Payer: Multiplan PHCS |
$741.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$864.50
|
| Rate for Payer: UHCCP Medicaid |
$432.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$815.12
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
IP
|
$6,620.00
|
|
|
Service Code
|
HCPCS 15936
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.60 |
| Max. Negotiated Rate |
$6,355.20 |
| Rate for Payer: Aetna Commercial |
$5,097.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Cash Price |
$3,310.00
|
| Rate for Payer: Cigna Commercial |
$5,494.60
|
| Rate for Payer: First Health Commercial |
$6,289.00
|
| Rate for Payer: Humana Commercial |
$5,627.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,428.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,885.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,986.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,825.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,965.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$860.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.20
|
| Rate for Payer: PHCS Commercial |
$6,355.20
|
| Rate for Payer: United Healthcare All Payer |
$5,825.60
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Professional
|
Both
|
$6,146.49
|
|
|
Service Code
|
HCPCS 15937
|
| Hospital Charge Code |
76100235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$807.05 |
| Max. Negotiated Rate |
$6,146.49 |
| Rate for Payer: Aetna Commercial |
$1,506.75
|
| Rate for Payer: Anthem Medicaid |
$807.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,146.49
|
| Rate for Payer: Cash Price |
$3,073.24
|
| Rate for Payer: Cash Price |
$3,073.24
|
| Rate for Payer: Cigna Commercial |
$1,445.88
|
| Rate for Payer: Healthspan PPO |
$1,204.79
|
| Rate for Payer: Humana Medicaid |
$807.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,303.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$823.19
|
| Rate for Payer: Molina Healthcare Passport |
$807.05
|
| Rate for Payer: Multiplan PHCS |
$3,687.89
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,302.54
|
| Rate for Payer: UHCCP Medicaid |
$2,151.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$815.12
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
OP
|
$4,911.49
|
|
|
Service Code
|
HCPCS 15937
|
| Hospital Charge Code |
761T0235
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$638.49 |
| Max. Negotiated Rate |
$4,715.03 |
| Rate for Payer: Aetna Commercial |
$3,781.85
|
| Rate for Payer: Anthem Medicaid |
$1,689.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,830.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,455.74
|
| Rate for Payer: Cash Price |
$2,455.74
|
| Rate for Payer: Cigna Commercial |
$4,076.54
|
| Rate for Payer: First Health Commercial |
$4,665.92
|
| Rate for Payer: Humana Commercial |
$4,174.77
|
| Rate for Payer: Humana KY Medicaid |
$1,689.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,027.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,624.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,722.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,322.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,683.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.56
|
| Rate for Payer: PHCS Commercial |
$4,715.03
|
| Rate for Payer: United Healthcare All Payer |
$4,322.11
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 15936
|
| Hospital Charge Code |
761P0234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.15 |
| Max. Negotiated Rate |
$2,120.00 |
| Rate for Payer: Aetna Commercial |
$1,289.28
|
| Rate for Payer: Anthem Medicaid |
$657.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,120.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,237.88
|
| Rate for Payer: Healthspan PPO |
$1,030.90
|
| Rate for Payer: Humana Medicaid |
$657.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,115.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$670.29
|
| Rate for Payer: Molina Healthcare Passport |
$657.15
|
| Rate for Payer: Multiplan PHCS |
$1,272.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,484.00
|
| Rate for Payer: UHCCP Medicaid |
$742.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.72
|
|
