|
EXPLOR REPAIR RECTAL INJURY(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
761P1906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,591.66
|
| Rate for Payer: Anthem Medicaid |
$581.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,452.12
|
| Rate for Payer: Healthspan PPO |
$1,342.28
|
| Rate for Payer: Humana Medicaid |
$581.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.62
|
| Rate for Payer: Molina Healthcare Passport |
$581.98
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.80
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Anthem Medicaid |
$546.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,264.83
|
| Rate for Payer: Healthspan PPO |
$1,156.61
|
| Rate for Payer: Humana Medicaid |
$546.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.53
|
| Rate for Payer: Molina Healthcare Passport |
$546.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.07
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLOR - RETROPERITONEAL BX(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
761P1976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.60 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Anthem Medicaid |
$546.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,264.83
|
| Rate for Payer: Healthspan PPO |
$1,156.61
|
| Rate for Payer: Humana Medicaid |
$546.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.53
|
| Rate for Payer: Molina Healthcare Passport |
$546.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.07
|
|
|
EXPLOR SCROTAL
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem Medicaid |
$199.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$451.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Humana KY Medicaid |
$199.12
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$201.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.49
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
EXPLOR SCROTAL
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.27 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$451.62
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.49
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
EXPLOR SCROTAL
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$618.28 |
| Rate for Payer: Aetna Commercial |
$618.28
|
| Rate for Payer: Anthem Medicaid |
$257.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.00
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$546.88
|
| Rate for Payer: Healthspan PPO |
$598.66
|
| Rate for Payer: Humana Medicaid |
$257.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.41
|
| Rate for Payer: Molina Healthcare Passport |
$257.26
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.30
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.83
|
|
|
EXPLOR SCROTAL(P
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
761P2146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$618.28 |
| Rate for Payer: Aetna Commercial |
$618.28
|
| Rate for Payer: Anthem Medicaid |
$257.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$579.00
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$546.88
|
| Rate for Payer: Healthspan PPO |
$598.66
|
| Rate for Payer: Humana Medicaid |
$257.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.41
|
| Rate for Payer: Molina Healthcare Passport |
$257.26
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.30
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.83
|
|
|
EXPL POSTSURG ABDOMEN
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.15 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,072.17
|
| Rate for Payer: Anthem Medicaid |
$482.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,020.65
|
| Rate for Payer: Healthspan PPO |
$1,054.15
|
| Rate for Payer: Humana Medicaid |
$482.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.79
|
| Rate for Payer: Molina Healthcare Passport |
$482.15
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.97
|
|
|
EXPL POSTSURG ABDOMEN
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPL POSTSURG ABDOMEN
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPL POSTSURG ABDOMEN(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
761P1422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.15 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,072.17
|
| Rate for Payer: Anthem Medicaid |
$482.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,020.65
|
| Rate for Payer: Healthspan PPO |
$1,054.15
|
| Rate for Payer: Humana Medicaid |
$482.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.79
|
| Rate for Payer: Molina Healthcare Passport |
$482.15
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.97
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Professional
|
Both
|
$6,345.94
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6,345.94 |
| Rate for Payer: Buckeye Medicare Advantage |
$6,345.94
|
| Rate for Payer: Cash Price |
$3,172.97
|
| Rate for Payer: Cash Price |
$3,172.97
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,807.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,442.16
|
| Rate for Payer: UHCCP Medicaid |
$2,221.08
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Facility
|
OP
|
$6,345.94
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$6,092.10 |
| Rate for Payer: Aetna Commercial |
$4,886.37
|
| Rate for Payer: Anthem Medicaid |
$2,182.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,949.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$3,172.97
|
| Rate for Payer: Cash Price |
$3,172.97
|
| Rate for Payer: Cigna Commercial |
$5,267.13
|
| Rate for Payer: First Health Commercial |
$6,028.64
|
| Rate for Payer: Humana Commercial |
$5,394.05
|
| Rate for Payer: Humana KY Medicaid |
$2,182.37
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,204.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,203.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,683.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,226.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,584.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,759.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,269.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.24
|
| Rate for Payer: PHCS Commercial |
$6,092.10
|
| Rate for Payer: United Healthcare All Payer |
$5,584.43
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Facility
|
IP
|
$6,345.94
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$824.97 |
| Max. Negotiated Rate |
$6,092.10 |
| Rate for Payer: Aetna Commercial |
$4,886.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,949.83
|
| Rate for Payer: Cash Price |
$3,172.97
|
| Rate for Payer: Cigna Commercial |
$5,267.13
|
| Rate for Payer: First Health Commercial |
$6,028.64
|
| Rate for Payer: Humana Commercial |
$5,394.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,203.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,683.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,903.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,584.43
|
| Rate for Payer: Ohio Health Group HMO |
$4,759.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,269.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$824.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,967.24
|
| Rate for Payer: PHCS Commercial |
$6,092.10
|
| Rate for Payer: United Healthcare All Payer |
$5,584.43
|
|
|
EXPL SUTURE SINUS ABDOMEN(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761P0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,500.00 |
| 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: Healthspan PPO |
$0.60
|
| 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
|
|
|
EXPL SUTURE SINUS ABDOMEN(T
|
Facility
|
IP
|
$3,845.94
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761T0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.97 |
| Max. Negotiated Rate |
$3,692.10 |
| Rate for Payer: Aetna Commercial |
$2,961.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,999.83
|
| Rate for Payer: Cash Price |
$1,922.97
|
| Rate for Payer: Cigna Commercial |
$3,192.13
|
| Rate for Payer: First Health Commercial |
$3,653.64
|
| Rate for Payer: Humana Commercial |
$3,269.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,153.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,153.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,384.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,192.24
|
| Rate for Payer: PHCS Commercial |
$3,692.10
|
| Rate for Payer: United Healthcare All Payer |
$3,384.43
|
|
|
EXPL SUTURE SINUS ABDOMEN(T
|
Facility
|
OP
|
$3,845.94
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761T0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$3,692.10 |
| Rate for Payer: Aetna Commercial |
$2,961.37
|
| Rate for Payer: Anthem Medicaid |
$1,322.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,999.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$1,922.97
|
| Rate for Payer: Cash Price |
$1,922.97
|
| Rate for Payer: Cigna Commercial |
$3,192.13
|
| Rate for Payer: First Health Commercial |
$3,653.64
|
| Rate for Payer: Humana Commercial |
$3,269.05
|
| Rate for Payer: Humana KY Medicaid |
$1,322.62
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,336.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,153.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,349.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,384.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$499.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,192.24
|
| Rate for Payer: PHCS Commercial |
$3,692.10
|
| Rate for Payer: United Healthcare All Payer |
$3,384.43
|
|
|
EXPNDR DERMASPAN M SMH 460-550
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
EXPNDR DERMASPAN M SMH 460-550
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
EXPNDR LOW HGT CPX3 TISS 250CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 250CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 350CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 350CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
