|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$3,510.00
|
| 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: 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 |
$1,350.00
|
| 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
|
IP
|
$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 POS/PPO/Traditional |
$4,794.26
|
| 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: 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 |
$1,843.95
|
| 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
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$3,830.96
|
| 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: 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 |
$1,473.45
|
| 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
|
$6,620.00
|
|
|
Service Code
|
HCPCS 15936
|
| Hospital Charge Code |
76100234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$657.15 |
| Max. Negotiated Rate |
$6,620.00 |
| Rate for Payer: Aetna Commercial |
$1,289.28
|
| Rate for Payer: Anthem Medicaid |
$657.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,620.00
|
| Rate for Payer: Cash Price |
$3,310.00
|
| Rate for Payer: Cash Price |
$3,310.00
|
| 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 |
$3,972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,634.00
|
| Rate for Payer: UHCCP Medicaid |
$2,317.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.72
|
|
|
EXC SAC PR ULC MUS/MYO F/S GRF
|
Facility
|
OP
|
$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 Medicaid |
$2,276.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,163.60
|
| 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 |
$3,310.00
|
| 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: Humana KY Medicaid |
$2,276.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,299.79
|
| 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 |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,322.30
|
| 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 SHOULDER LES SC 3 CM/>
|
Professional
|
Both
|
$5,950.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.88 |
| Max. Negotiated Rate |
$5,950.00 |
| Rate for Payer: Aetna Commercial |
$642.25
|
| Rate for Payer: Anthem Medicaid |
$301.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,950.00
|
| Rate for Payer: Cash Price |
$2,975.00
|
| Rate for Payer: Cash Price |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$731.30
|
| Rate for Payer: Healthspan PPO |
$457.68
|
| Rate for Payer: Humana Medicaid |
$301.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$531.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.92
|
| Rate for Payer: Molina Healthcare Passport |
$301.88
|
| Rate for Payer: Multiplan PHCS |
$3,570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,165.00
|
| Rate for Payer: UHCCP Medicaid |
$2,082.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.90
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
OP
|
$5,950.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$5,712.00 |
| Rate for Payer: Aetna Commercial |
$4,581.50
|
| Rate for Payer: Anthem Medicaid |
$2,046.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,641.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,975.00
|
| Rate for Payer: Cash Price |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$4,938.50
|
| Rate for Payer: First Health Commercial |
$5,652.50
|
| Rate for Payer: Humana Commercial |
$5,057.50
|
| Rate for Payer: Humana KY Medicaid |
$2,046.20
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,067.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,879.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,391.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,087.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,236.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$773.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,844.50
|
| Rate for Payer: PHCS Commercial |
$5,712.00
|
| Rate for Payer: United Healthcare All Payer |
$5,236.00
|
|
|
EXC SHOULDER LES SC 3 CM/>
|
Facility
|
IP
|
$5,950.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$5,712.00 |
| Rate for Payer: Aetna Commercial |
$4,581.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,641.00
|
| Rate for Payer: Cash Price |
$2,975.00
|
| Rate for Payer: Cigna Commercial |
$4,938.50
|
| Rate for Payer: First Health Commercial |
$5,652.50
|
| Rate for Payer: Humana Commercial |
$5,057.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,879.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,391.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,236.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$773.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,844.50
|
| Rate for Payer: PHCS Commercial |
$5,712.00
|
| Rate for Payer: United Healthcare All Payer |
$5,236.00
|
|
|
EXC SHOULDER LES SC 3 CM/>(P
|
Professional
|
Both
|
$740.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
761P0437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Aetna Commercial |
$642.25
|
| Rate for Payer: Anthem Medicaid |
$301.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$740.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$731.30
|
| Rate for Payer: Healthspan PPO |
$457.68
|
| Rate for Payer: Humana Medicaid |
$301.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$531.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$307.92
|
| Rate for Payer: Molina Healthcare Passport |
$301.88
|
| Rate for Payer: Multiplan PHCS |
$444.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$518.00
|
| Rate for Payer: UHCCP Medicaid |
$259.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$304.90
|
|
|
EXC SHOULDER LES SC 3 CM/>(T
|
Facility
|
IP
|
$5,210.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
761T0437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.30 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.10
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
EXC SHOULDER LES SC 3 CM/>(T
|
Facility
|
OP
|
$5,210.00
|
|
|
Service Code
|
HCPCS 23071
|
| Hospital Charge Code |
761T0437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.30 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem Medicaid |
$1,791.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| 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 |
$2,605.00
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Humana KY Medicaid |
$1,791.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.10
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
IP
|
$7,263.71
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.28 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$5,593.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,665.69
|
| Rate for Payer: Cash Price |
$3,631.86
|
| Rate for Payer: Cigna Commercial |
$6,028.88
|
| Rate for Payer: First Health Commercial |
$6,900.52
|
| Rate for Payer: Humana Commercial |
$6,174.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,956.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,360.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,392.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,447.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.75
|
| Rate for Payer: PHCS Commercial |
$6,973.16
|
| Rate for Payer: United Healthcare All Payer |
$6,392.06
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Professional
|
Both
|
$7,263.71
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.90 |
| Max. Negotiated Rate |
$7,263.71 |
| Rate for Payer: Aetna Commercial |
$1,065.70
|
| Rate for Payer: Anthem Medicaid |
$500.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,263.71
|
| Rate for Payer: Cash Price |
$3,631.86
|
| Rate for Payer: Cash Price |
$3,631.86
|
| Rate for Payer: Cigna Commercial |
$1,212.82
|
| Rate for Payer: Healthspan PPO |
$760.45
|
| Rate for Payer: Humana Medicaid |
$500.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.92
|
| Rate for Payer: Molina Healthcare Passport |
$500.90
|
| Rate for Payer: Multiplan PHCS |
$4,358.23
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,084.60
|
| Rate for Payer: UHCCP Medicaid |
$2,542.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.91
|
|
|
EXC SHOULDER TUM DEEP 5 CM/>
|
Facility
|
OP
|
$7,263.71
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
76100438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$944.28 |
| Max. Negotiated Rate |
$6,973.16 |
| Rate for Payer: Aetna Commercial |
$5,593.06
|
| Rate for Payer: Anthem Medicaid |
$2,497.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,665.69
|
| 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 |
$3,631.86
|
| Rate for Payer: Cash Price |
$3,631.86
|
| Rate for Payer: Cigna Commercial |
$6,028.88
|
| Rate for Payer: First Health Commercial |
$6,900.52
|
| Rate for Payer: Humana Commercial |
$6,174.15
|
| Rate for Payer: Humana KY Medicaid |
$2,497.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,523.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,956.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,360.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,548.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,392.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,447.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,251.75
|
| Rate for Payer: PHCS Commercial |
$6,973.16
|
| Rate for Payer: United Healthcare All Payer |
$6,392.06
|
|
|
EXC SHOULDER TUM DEEP 5 CM/(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
761P0438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,212.82 |
| Rate for Payer: Aetna Commercial |
$1,065.70
|
| Rate for Payer: Anthem Medicaid |
$500.90
|
| 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 |
$1,212.82
|
| Rate for Payer: Healthspan PPO |
$760.45
|
| Rate for Payer: Humana Medicaid |
$500.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.92
|
| Rate for Payer: Molina Healthcare Passport |
$500.90
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.91
|
|
|
EXC SHOULDER TUM DEEP 5 CM/(T
|
Facility
|
IP
|
$6,163.71
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
761T0438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.28 |
| Max. Negotiated Rate |
$5,917.16 |
| Rate for Payer: Aetna Commercial |
$4,746.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,807.69
|
| Rate for Payer: Cash Price |
$3,081.86
|
| Rate for Payer: Cigna Commercial |
$5,115.88
|
| Rate for Payer: First Health Commercial |
$5,855.52
|
| Rate for Payer: Humana Commercial |
$5,239.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,054.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,548.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,849.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,424.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,622.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,232.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.75
|
| Rate for Payer: PHCS Commercial |
$5,917.16
|
| Rate for Payer: United Healthcare All Payer |
$5,424.06
|
|
|
EXC SHOULDER TUM DEEP 5 CM/(T
|
Facility
|
OP
|
$6,163.71
|
|
|
Service Code
|
HCPCS 23073
|
| Hospital Charge Code |
761T0438
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$801.28 |
| Max. Negotiated Rate |
$5,917.16 |
| Rate for Payer: Aetna Commercial |
$4,746.06
|
| Rate for Payer: Anthem Medicaid |
$2,119.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,807.69
|
| 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 |
$3,081.86
|
| Rate for Payer: Cash Price |
$3,081.86
|
| Rate for Payer: Cigna Commercial |
$5,115.88
|
| Rate for Payer: First Health Commercial |
$5,855.52
|
| Rate for Payer: Humana Commercial |
$5,239.15
|
| Rate for Payer: Humana KY Medicaid |
$2,119.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,141.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,054.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,548.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,162.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,424.06
|
| Rate for Payer: Ohio Health Group HMO |
$4,622.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,232.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$801.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.75
|
| Rate for Payer: PHCS Commercial |
$5,917.16
|
| Rate for Payer: United Healthcare All Payer |
$5,424.06
|
|
|
EXC SKIN HIDRADENITIS
|
Facility
|
OP
|
$6,173.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$802.49 |
| Max. Negotiated Rate |
$5,926.08 |
| Rate for Payer: Aetna Commercial |
$4,753.21
|
| Rate for Payer: Anthem Medicaid |
$2,122.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,814.94
|
| 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 |
$3,086.50
|
| Rate for Payer: Cash Price |
$3,086.50
|
| Rate for Payer: Cigna Commercial |
$5,123.59
|
| Rate for Payer: First Health Commercial |
$5,864.35
|
| Rate for Payer: Humana Commercial |
$5,247.05
|
| Rate for Payer: Humana KY Medicaid |
$2,122.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,061.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,555.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,165.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,432.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,629.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$802.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,913.63
|
| Rate for Payer: PHCS Commercial |
$5,926.08
|
| Rate for Payer: United Healthcare All Payer |
$5,432.24
|
|
|
EXC SKIN HIDRADENITIS
|
Facility
|
IP
|
$6,173.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$802.49 |
| Max. Negotiated Rate |
$5,926.08 |
| Rate for Payer: Aetna Commercial |
$4,753.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,814.94
|
| Rate for Payer: Cash Price |
$3,086.50
|
| Rate for Payer: Cigna Commercial |
$5,123.59
|
| Rate for Payer: First Health Commercial |
$5,864.35
|
| Rate for Payer: Humana Commercial |
$5,247.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,061.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,555.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,851.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,432.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,629.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$802.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,913.63
|
| Rate for Payer: PHCS Commercial |
$5,926.08
|
| Rate for Payer: United Healthcare All Payer |
$5,432.24
|
|
|
EXC SKIN HIDRADENITIS
|
Professional
|
Both
|
$6,173.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$6,173.00 |
| Rate for Payer: Aetna Commercial |
$330.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.62
|
| Rate for Payer: Anthem Medicaid |
$158.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,173.00
|
| Rate for Payer: Cash Price |
$3,086.50
|
| Rate for Payer: Cash Price |
$3,086.50
|
| Rate for Payer: Cigna Commercial |
$302.67
|
| Rate for Payer: Healthspan PPO |
$382.12
|
| Rate for Payer: Humana Medicaid |
$158.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.45
|
| Rate for Payer: Molina Healthcare Passport |
$158.28
|
| Rate for Payer: Multiplan PHCS |
$3,703.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,321.10
|
| Rate for Payer: UHCCP Medicaid |
$141.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.86
|
|
|
EXC SKIN HIDRADENITIS(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
761P0069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$330.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.62
|
| Rate for Payer: Anthem Medicaid |
$158.28
|
| 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 |
$302.67
|
| Rate for Payer: Healthspan PPO |
$382.12
|
| Rate for Payer: Humana Medicaid |
$158.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$161.45
|
| Rate for Payer: Molina Healthcare Passport |
$158.28
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$141.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.86
|
|
|
EXC SKIN HIDRADENITIS(T
|
Facility
|
IP
|
$5,473.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
761T0069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$711.49 |
| Max. Negotiated Rate |
$5,254.08 |
| Rate for Payer: Aetna Commercial |
$4,214.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,268.94
|
| Rate for Payer: Cash Price |
$2,736.50
|
| Rate for Payer: Cigna Commercial |
$4,542.59
|
| Rate for Payer: First Health Commercial |
$5,199.35
|
| Rate for Payer: Humana Commercial |
$4,652.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,487.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,039.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,641.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,816.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,104.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,094.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,696.63
|
| Rate for Payer: PHCS Commercial |
$5,254.08
|
| Rate for Payer: United Healthcare All Payer |
$4,816.24
|
|
|
EXC SKIN HIDRADENITIS(T
|
Facility
|
OP
|
$5,473.00
|
|
|
Service Code
|
HCPCS 11450
|
| Hospital Charge Code |
761T0069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$711.49 |
| Max. Negotiated Rate |
$5,254.08 |
| Rate for Payer: Aetna Commercial |
$4,214.21
|
| Rate for Payer: Anthem Medicaid |
$1,882.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,268.94
|
| 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 |
$2,736.50
|
| Rate for Payer: Cash Price |
$2,736.50
|
| Rate for Payer: Cigna Commercial |
$4,542.59
|
| Rate for Payer: First Health Commercial |
$5,199.35
|
| Rate for Payer: Humana Commercial |
$4,652.05
|
| Rate for Payer: Humana KY Medicaid |
$1,882.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,901.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,487.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,039.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,919.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,816.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,104.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,094.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,696.63
|
| Rate for Payer: PHCS Commercial |
$5,254.08
|
| Rate for Payer: United Healthcare All Payer |
$4,816.24
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Facility
|
IP
|
$5,208.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
761T0073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.04 |
| Max. Negotiated Rate |
$4,999.69 |
| Rate for Payer: Aetna Commercial |
$4,010.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,062.25
|
| Rate for Payer: Cash Price |
$2,604.00
|
| Rate for Payer: Cigna Commercial |
$4,322.65
|
| Rate for Payer: First Health Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial |
$4,426.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,270.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,843.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,562.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,614.48
|
| Rate for Payer: PHCS Commercial |
$4,999.69
|
| Rate for Payer: United Healthcare All Payer |
$4,583.05
|
|
|
EXC SKN SUBQ TIS HIDRAD PERIAN
|
Facility
|
OP
|
$5,208.01
|
|
|
Service Code
|
HCPCS 11470
|
| Hospital Charge Code |
761T0073
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$677.04 |
| Max. Negotiated Rate |
$4,999.69 |
| Rate for Payer: Aetna Commercial |
$4,010.17
|
| Rate for Payer: Anthem Medicaid |
$1,791.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,062.25
|
| 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 |
$2,604.00
|
| Rate for Payer: Cash Price |
$2,604.00
|
| Rate for Payer: Cigna Commercial |
$4,322.65
|
| Rate for Payer: First Health Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial |
$4,426.81
|
| Rate for Payer: Humana KY Medicaid |
$1,791.03
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,270.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,843.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,826.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,614.48
|
| Rate for Payer: PHCS Commercial |
$4,999.69
|
| Rate for Payer: United Healthcare All Payer |
$4,583.05
|
|
