|
EXC THROMBOS HEMMORRHOID XTRNL
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
76101924
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna Commercial |
$153.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.39
|
| Rate for Payer: Anthem Medicaid |
$58.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.00
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$217.17
|
| Rate for Payer: Healthspan PPO |
$194.85
|
| Rate for Payer: Humana Medicaid |
$58.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.59
|
| Rate for Payer: Molina Healthcare Passport |
$58.42
|
| Rate for Payer: Multiplan PHCS |
$209.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.30
|
| Rate for Payer: UHCCP Medicaid |
$78.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.00
|
|
|
EXC THROMBOS HEMMORRHOID XTRNL
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
76101924
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$335.04 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
EXC THROMBOS HEMMORRHOID XTRNL
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
76101924
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$268.73
|
| Rate for Payer: Anthem Medicaid |
$120.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.22
|
| 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 |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$289.67
|
| Rate for Payer: First Health Commercial |
$331.55
|
| Rate for Payer: Humana Commercial |
$296.65
|
| Rate for Payer: Humana KY Medicaid |
$120.02
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$121.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.12
|
| Rate for Payer: Ohio Health Group HMO |
$261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.19
|
| Rate for Payer: PHCS Commercial |
$335.04
|
| Rate for Payer: United Healthcare All Payer |
$307.12
|
|
|
EXC THROMBOS HEMMORRHOID XTRNL
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
45000272
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.87 |
| Max. Negotiated Rate |
$1,439.04 |
| Rate for Payer: Aetna Commercial |
$1,154.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.22
|
| Rate for Payer: Cash Price |
$749.50
|
| Rate for Payer: Cigna Commercial |
$1,244.17
|
| Rate for Payer: First Health Commercial |
$1,424.05
|
| Rate for Payer: Humana Commercial |
$1,274.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$449.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.69
|
| Rate for Payer: PHCS Commercial |
$1,439.04
|
| Rate for Payer: United Healthcare All Payer |
$1,319.12
|
|
|
EXC THROMBOS HEMMORRHOID XTRNL
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
761P1924
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna Commercial |
$153.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.39
|
| Rate for Payer: Anthem Medicaid |
$58.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$349.00
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cash Price |
$174.50
|
| Rate for Payer: Cigna Commercial |
$217.17
|
| Rate for Payer: Healthspan PPO |
$194.85
|
| Rate for Payer: Humana Medicaid |
$58.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.59
|
| Rate for Payer: Molina Healthcare Passport |
$58.42
|
| Rate for Payer: Multiplan PHCS |
$209.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.30
|
| Rate for Payer: UHCCP Medicaid |
$78.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.00
|
|
|
EXC THROMBOS HEMMORRHOID XTRNL
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
HCPCS 46320
|
| Hospital Charge Code |
45000272
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.87 |
| Max. Negotiated Rate |
$1,439.04 |
| Rate for Payer: Aetna Commercial |
$1,154.23
|
| Rate for Payer: Anthem Medicaid |
$515.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,169.22
|
| 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 |
$749.50
|
| Rate for Payer: Cash Price |
$749.50
|
| Rate for Payer: Cigna Commercial |
$1,244.17
|
| Rate for Payer: First Health Commercial |
$1,424.05
|
| Rate for Payer: Humana Commercial |
$1,274.15
|
| Rate for Payer: Humana KY Medicaid |
$515.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$520.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,229.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,106.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$525.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,319.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,124.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$464.69
|
| Rate for Payer: PHCS Commercial |
$1,439.04
|
| Rate for Payer: United Healthcare All Payer |
$1,319.12
|
|
|
EXC TISSUE HIDRADENITIS AX
|
Facility
|
IP
|
$7,048.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
76100070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$916.24 |
| Max. Negotiated Rate |
$6,766.08 |
| Rate for Payer: Aetna Commercial |
$5,426.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.44
|
| Rate for Payer: Cash Price |
$3,524.00
|
| Rate for Payer: Cigna Commercial |
$5,849.84
|
| Rate for Payer: First Health Commercial |
$6,695.60
|
| Rate for Payer: Humana Commercial |
$5,990.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,114.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.88
|
| Rate for Payer: PHCS Commercial |
$6,766.08
|
| Rate for Payer: United Healthcare All Payer |
$6,202.24
|
|
|
EXC TISSUE HIDRADENITIS AX
|
Facility
|
OP
|
$7,048.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
76100070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$916.24 |
| Max. Negotiated Rate |
$6,766.08 |
| Rate for Payer: Aetna Commercial |
$5,426.96
|
| Rate for Payer: Anthem Medicaid |
$2,423.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,497.44
|
| 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 |
$3,524.00
|
| Rate for Payer: Cash Price |
$3,524.00
|
| Rate for Payer: Cigna Commercial |
$5,849.84
|
| Rate for Payer: First Health Commercial |
$6,695.60
|
| Rate for Payer: Humana Commercial |
$5,990.80
|
| Rate for Payer: Humana KY Medicaid |
$2,423.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,448.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,779.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,201.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,472.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,202.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,286.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,409.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,184.88
|
| Rate for Payer: PHCS Commercial |
$6,766.08
|
| Rate for Payer: United Healthcare All Payer |
$6,202.24
|
|
|
EXC TISSUE HIDRADENITIS AX
|
Professional
|
Both
|
$7,048.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
76100070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$7,048.00 |
| Rate for Payer: Aetna Commercial |
$440.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$200.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,048.00
|
| Rate for Payer: Cash Price |
$3,524.00
|
| Rate for Payer: Cash Price |
$3,524.00
|
| Rate for Payer: Cigna Commercial |
$404.26
|
| Rate for Payer: Healthspan PPO |
$502.71
|
| Rate for Payer: Humana Medicaid |
$200.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.48
|
| Rate for Payer: Molina Healthcare Passport |
$200.47
|
| Rate for Payer: Multiplan PHCS |
$4,228.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,933.60
|
| Rate for Payer: UHCCP Medicaid |
$177.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.47
|
|
|
EXC TISSUE HIDRADENITIS AX(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
761P0070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$440.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$200.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$404.26
|
| Rate for Payer: Healthspan PPO |
$502.71
|
| Rate for Payer: Humana Medicaid |
$200.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$390.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.48
|
| Rate for Payer: Molina Healthcare Passport |
$200.47
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$177.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.47
|
|
|
EXC TISSUE HIDRADENITIS AX(T
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
761T0070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.74 |
| Max. Negotiated Rate |
$6,046.08 |
| Rate for Payer: Aetna Commercial |
$4,849.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,912.44
|
| Rate for Payer: Cash Price |
$3,149.00
|
| Rate for Payer: Cigna Commercial |
$5,227.34
|
| Rate for Payer: First Health Commercial |
$5,983.10
|
| Rate for Payer: Humana Commercial |
$5,353.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,164.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,647.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,889.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,542.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,723.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,259.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,952.38
|
| Rate for Payer: PHCS Commercial |
$6,046.08
|
| Rate for Payer: United Healthcare All Payer |
$5,542.24
|
|
|
EXC TISSUE HIDRADENITIS AX(T
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS 11451
|
| Hospital Charge Code |
761T0070
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.74 |
| Max. Negotiated Rate |
$6,046.08 |
| Rate for Payer: Aetna Commercial |
$4,849.46
|
| Rate for Payer: Anthem Medicaid |
$2,165.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,912.44
|
| 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 |
$3,149.00
|
| Rate for Payer: Cash Price |
$3,149.00
|
| Rate for Payer: Cigna Commercial |
$5,227.34
|
| Rate for Payer: First Health Commercial |
$5,983.10
|
| Rate for Payer: Humana Commercial |
$5,353.30
|
| Rate for Payer: Humana KY Medicaid |
$2,165.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,187.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,164.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,647.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,209.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,542.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,723.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,259.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$818.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,952.38
|
| Rate for Payer: PHCS Commercial |
$6,046.08
|
| Rate for Payer: United Healthcare All Payer |
$5,542.24
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Facility
|
IP
|
$4,694.12
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
761T0241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.24 |
| Max. Negotiated Rate |
$4,506.36 |
| Rate for Payer: Aetna Commercial |
$3,614.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.41
|
| Rate for Payer: Cash Price |
$2,347.06
|
| Rate for Payer: Cigna Commercial |
$3,896.12
|
| Rate for Payer: First Health Commercial |
$4,459.41
|
| Rate for Payer: Humana Commercial |
$3,990.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,130.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,520.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.18
|
| Rate for Payer: PHCS Commercial |
$4,506.36
|
| Rate for Payer: United Healthcare All Payer |
$4,130.83
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Professional
|
Both
|
$7,194.12
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$975.57 |
| Max. Negotiated Rate |
$7,194.12 |
| Rate for Payer: Aetna Commercial |
$1,688.96
|
| Rate for Payer: Anthem Medicaid |
$975.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,194.12
|
| Rate for Payer: Cash Price |
$3,597.06
|
| Rate for Payer: Cash Price |
$3,597.06
|
| Rate for Payer: Cigna Commercial |
$1,608.25
|
| Rate for Payer: Healthspan PPO |
$1,350.48
|
| Rate for Payer: Humana Medicaid |
$975.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,473.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$995.08
|
| Rate for Payer: Molina Healthcare Passport |
$975.57
|
| Rate for Payer: Multiplan PHCS |
$4,316.47
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,035.88
|
| Rate for Payer: UHCCP Medicaid |
$2,517.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$985.33
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
761P0241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,688.96
|
| Rate for Payer: Anthem Medicaid |
$975.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,608.25
|
| Rate for Payer: Healthspan PPO |
$1,350.48
|
| Rate for Payer: Humana Medicaid |
$975.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,473.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$995.08
|
| Rate for Payer: Molina Healthcare Passport |
$975.57
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$985.33
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Facility
|
OP
|
$4,694.12
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
761T0241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.24 |
| Max. Negotiated Rate |
$4,506.36 |
| Rate for Payer: Aetna Commercial |
$3,614.47
|
| Rate for Payer: Anthem Medicaid |
$1,614.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,661.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$2,347.06
|
| Rate for Payer: Cash Price |
$2,347.06
|
| Rate for Payer: Cigna Commercial |
$3,896.12
|
| Rate for Payer: First Health Commercial |
$4,459.41
|
| Rate for Payer: Humana Commercial |
$3,990.00
|
| Rate for Payer: Humana KY Medicaid |
$1,614.31
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,849.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,464.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,646.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,130.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,520.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.18
|
| Rate for Payer: PHCS Commercial |
$4,506.36
|
| Rate for Payer: United Healthcare All Payer |
$4,130.83
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Facility
|
OP
|
$7,194.12
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$935.24 |
| Max. Negotiated Rate |
$6,906.36 |
| Rate for Payer: Aetna Commercial |
$5,539.47
|
| Rate for Payer: Anthem Medicaid |
$2,474.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,611.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$3,597.06
|
| Rate for Payer: Cash Price |
$3,597.06
|
| Rate for Payer: Cigna Commercial |
$5,971.12
|
| Rate for Payer: First Health Commercial |
$6,834.41
|
| Rate for Payer: Humana Commercial |
$6,115.00
|
| Rate for Payer: Humana KY Medicaid |
$2,474.06
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,899.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,309.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,523.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,330.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,395.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,230.18
|
| Rate for Payer: PHCS Commercial |
$6,906.36
|
| Rate for Payer: United Healthcare All Payer |
$6,330.83
|
|
|
EXC TRCH PRULC MUSMYO FS WOSTC
|
Facility
|
IP
|
$7,194.12
|
|
|
Service Code
|
HCPCS 15958
|
| Hospital Charge Code |
76100241
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$935.24 |
| Max. Negotiated Rate |
$6,906.36 |
| Rate for Payer: Aetna Commercial |
$5,539.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,611.41
|
| Rate for Payer: Cash Price |
$3,597.06
|
| Rate for Payer: Cigna Commercial |
$5,971.12
|
| Rate for Payer: First Health Commercial |
$6,834.41
|
| Rate for Payer: Humana Commercial |
$6,115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,899.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,309.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,330.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,395.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,230.18
|
| Rate for Payer: PHCS Commercial |
$6,906.36
|
| Rate for Payer: United Healthcare All Payer |
$6,330.83
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Facility
|
IP
|
$5,564.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.32 |
| Max. Negotiated Rate |
$5,341.44 |
| Rate for Payer: Aetna Commercial |
$4,284.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,339.92
|
| Rate for Payer: Cash Price |
$2,782.00
|
| Rate for Payer: Cigna Commercial |
$4,618.12
|
| Rate for Payer: First Health Commercial |
$5,285.80
|
| Rate for Payer: Humana Commercial |
$4,729.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,562.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,106.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,669.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,896.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,724.84
|
| Rate for Payer: PHCS Commercial |
$5,341.44
|
| Rate for Payer: United Healthcare All Payer |
$4,896.32
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Facility
|
OP
|
$5,564.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$723.32 |
| Max. Negotiated Rate |
$5,341.44 |
| Rate for Payer: Aetna Commercial |
$4,284.28
|
| Rate for Payer: Anthem Medicaid |
$1,913.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,339.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$2,782.00
|
| Rate for Payer: Cash Price |
$2,782.00
|
| Rate for Payer: Cigna Commercial |
$4,618.12
|
| Rate for Payer: First Health Commercial |
$5,285.80
|
| Rate for Payer: Humana Commercial |
$4,729.40
|
| Rate for Payer: Humana KY Medicaid |
$1,913.46
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,562.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,106.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,896.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,724.84
|
| Rate for Payer: PHCS Commercial |
$5,341.44
|
| Rate for Payer: United Healthcare All Payer |
$4,896.32
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
761T0240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.32 |
| Max. Negotiated Rate |
$4,093.44 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cigna Commercial |
$3,539.12
|
| Rate for Payer: First Health Commercial |
$4,050.80
|
| Rate for Payer: Humana Commercial |
$3,624.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.84
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
761P0240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,373.18 |
| Rate for Payer: Aetna Commercial |
$1,373.18
|
| Rate for Payer: Anthem Medicaid |
$623.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,312.44
|
| Rate for Payer: Healthspan PPO |
$1,097.98
|
| Rate for Payer: Humana Medicaid |
$623.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$635.67
|
| Rate for Payer: Molina Healthcare Passport |
$623.21
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$629.44
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Professional
|
Both
|
$5,564.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
76100240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$623.21 |
| Max. Negotiated Rate |
$5,564.00 |
| Rate for Payer: Aetna Commercial |
$1,373.18
|
| Rate for Payer: Anthem Medicaid |
$623.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,564.00
|
| Rate for Payer: Cash Price |
$2,782.00
|
| Rate for Payer: Cash Price |
$2,782.00
|
| Rate for Payer: Cigna Commercial |
$1,312.44
|
| Rate for Payer: Healthspan PPO |
$1,097.98
|
| Rate for Payer: Humana Medicaid |
$623.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$635.67
|
| Rate for Payer: Molina Healthcare Passport |
$623.21
|
| Rate for Payer: Multiplan PHCS |
$3,338.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,894.80
|
| Rate for Payer: UHCCP Medicaid |
$1,947.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$629.44
|
|
|
EXC TRCH PRULC W/SF CLSR W/OST
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15953
|
| Hospital Charge Code |
761T0240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.32 |
| Max. Negotiated Rate |
$4,343.37 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem Medicaid |
$1,466.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cigna Commercial |
$3,539.12
|
| Rate for Payer: First Health Commercial |
$4,050.80
|
| Rate for Payer: Humana Commercial |
$3,624.40
|
| Rate for Payer: Humana KY Medicaid |
$1,466.39
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,495.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.84
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
EXC TUMOR - FOREARM - WRIST
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
76100575
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| 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 |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
