|
EVOLUTN PS INS S6 PLUS 24MM R
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
EVOLUTN PS INS S6 PLUS 24MM R
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
EVOLVE+2 HEAD SZ 20MM 496-H220
|
Facility
|
OP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem Medicaid |
$3,284.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Humana KY Medicaid |
$3,284.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,350.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
EVOLVE+2 HEAD SZ 20MM 496-H220
|
Facility
|
IP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
EVOLVE + 2 HEAD SZ 26MM
|
Facility
|
IP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
EVOLVE + 2 HEAD SZ 26MM
|
Facility
|
OP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem Medicaid |
$3,284.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Humana KY Medicaid |
$3,284.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,350.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
EVOLVE+4 HEAD SZ 24MM 496-H424
|
Facility
|
OP
|
$9,880.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.07 |
| Max. Negotiated Rate |
$9,485.04 |
| Rate for Payer: Aetna Commercial |
$7,607.79
|
| Rate for Payer: Anthem Medicaid |
$3,397.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,706.60
|
| Rate for Payer: Cash Price |
$4,940.12
|
| Rate for Payer: Cigna Commercial |
$8,200.61
|
| Rate for Payer: First Health Commercial |
$9,386.24
|
| Rate for Payer: Humana Commercial |
$8,398.21
|
| Rate for Payer: Humana KY Medicaid |
$3,397.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,101.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,291.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,465.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,694.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,904.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,595.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.37
|
| Rate for Payer: PHCS Commercial |
$9,485.04
|
| Rate for Payer: United Healthcare All Payer |
$8,694.62
|
|
|
EVOLVE+4 HEAD SZ 24MM 496-H424
|
Facility
|
IP
|
$9,880.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.07 |
| Max. Negotiated Rate |
$9,485.04 |
| Rate for Payer: Aetna Commercial |
$7,607.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,706.60
|
| Rate for Payer: Cash Price |
$4,940.12
|
| Rate for Payer: Cigna Commercial |
$8,200.61
|
| Rate for Payer: First Health Commercial |
$9,386.24
|
| Rate for Payer: Humana Commercial |
$8,398.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,101.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,291.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,694.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,904.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,595.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.37
|
| Rate for Payer: PHCS Commercial |
$9,485.04
|
| Rate for Payer: United Healthcare All Payer |
$8,694.62
|
|
|
EVOLVE STEM SZ 7.5MM STD
|
Facility
|
OP
|
$11,728.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,518.44 |
| Max. Negotiated Rate |
$11,259.01 |
| Rate for Payer: Aetna Commercial |
$9,030.67
|
| Rate for Payer: Anthem Medicaid |
$4,033.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,147.95
|
| Rate for Payer: Cash Price |
$5,864.07
|
| Rate for Payer: Cigna Commercial |
$9,734.36
|
| Rate for Payer: First Health Commercial |
$11,141.73
|
| Rate for Payer: Humana Commercial |
$9,968.92
|
| Rate for Payer: Humana KY Medicaid |
$4,033.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,074.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,617.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,655.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,518.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,114.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,320.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,796.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,382.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,203.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,092.42
|
| Rate for Payer: PHCS Commercial |
$11,259.01
|
| Rate for Payer: United Healthcare All Payer |
$10,320.76
|
|
|
EVOLVE STEM SZ 7.5MM STD
|
Facility
|
IP
|
$11,728.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,518.44 |
| Max. Negotiated Rate |
$11,259.01 |
| Rate for Payer: Aetna Commercial |
$9,030.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,147.95
|
| Rate for Payer: Cash Price |
$5,864.07
|
| Rate for Payer: Cigna Commercial |
$9,734.36
|
| Rate for Payer: First Health Commercial |
$11,141.73
|
| Rate for Payer: Humana Commercial |
$9,968.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,617.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,655.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,518.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,320.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,796.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,382.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,203.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,092.42
|
| Rate for Payer: PHCS Commercial |
$11,259.01
|
| Rate for Payer: United Healthcare All Payer |
$10,320.76
|
|
|
EX ABSCRSS FISTULA SIN TRAC(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
320P0183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$98.54 |
| Rate for Payer: Aetna Commercial |
$97.89
|
| Rate for Payer: Ambetter Exchange |
$54.79
|
| Rate for Payer: Anthem Medicaid |
$52.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.75
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$98.54
|
| Rate for Payer: Healthspan PPO |
$91.72
|
| Rate for Payer: Humana Medicaid |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.09
|
| Rate for Payer: Molina Healthcare Passport |
$52.05
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.23
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.79
|
|
|
EX ABSCRSS FISTULA SIN TRAC(T
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
320T0183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
EX ABSCRSS FISTULA SIN TRAC(T
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
320T0183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$709.27 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.84 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
EX ABSCRSS FISTULA SIN TRACT
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 76080
|
| Hospital Charge Code |
32000183
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial |
$97.89
|
| Rate for Payer: Ambetter Exchange |
$54.79
|
| Rate for Payer: Anthem Medicaid |
$52.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.75
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$98.54
|
| Rate for Payer: Healthspan PPO |
$91.72
|
| Rate for Payer: Humana Medicaid |
$52.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.09
|
| Rate for Payer: Molina Healthcare Passport |
$52.05
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.23
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.79
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Professional
|
Both
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$936.60 |
| Rate for Payer: Aetna Commercial |
$177.35
|
| Rate for Payer: Ambetter Exchange |
$107.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$114.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.32
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$221.62
|
| Rate for Payer: Healthspan PPO |
$215.25
|
| Rate for Payer: Humana Medicaid |
$114.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.57
|
| Rate for Payer: Molina Healthcare Passport |
$114.28
|
| Rate for Payer: Multiplan PHCS |
$936.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.10
|
| Rate for Payer: UHCCP Medicaid |
$82.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.77
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
EXAM/BIOPSY OF VULVA W/SCOPE
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
76102165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761P2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$318.00 |
| Rate for Payer: Aetna Commercial |
$177.35
|
| Rate for Payer: Ambetter Exchange |
$107.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$114.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.32
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$221.62
|
| Rate for Payer: Healthspan PPO |
$215.25
|
| Rate for Payer: Humana Medicaid |
$114.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$116.57
|
| Rate for Payer: Molina Healthcare Passport |
$114.28
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.10
|
| Rate for Payer: UHCCP Medicaid |
$82.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$115.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.77
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(T
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761T2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem Medicaid |
$354.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Humana KY Medicaid |
$354.56
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$358.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.39
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
EXAM/BIOPSY OF VULVA W/SCOP(T
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 56821
|
| Hospital Charge Code |
761T2165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.30 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.39
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
OP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.88 |
| Max. Negotiated Rate |
$997.44 |
| Rate for Payer: Aetna Commercial |
$800.03
|
| Rate for Payer: Anthem Medicaid |
$357.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$862.37
|
| Rate for Payer: First Health Commercial |
$987.05
|
| Rate for Payer: Humana Commercial |
$883.15
|
| Rate for Payer: Humana KY Medicaid |
$357.31
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$360.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$851.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$766.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$364.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.32
|
| Rate for Payer: Ohio Health Group HMO |
$779.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$716.91
|
| Rate for Payer: PHCS Commercial |
$997.44
|
| Rate for Payer: United Healthcare All Payer |
$914.32
|
|
|
EXAM OF CERVIX W/SCOPE
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.89 |
| Max. Negotiated Rate |
$623.40 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Ambetter Exchange |
$86.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.30
|
| Rate for Payer: Anthem Medicaid |
$49.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$103.21
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$162.98
|
| Rate for Payer: Healthspan PPO |
$158.95
|
| Rate for Payer: Humana Medicaid |
$49.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$118.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.89
|
| Rate for Payer: Molina Healthcare Passport |
$49.89
|
| Rate for Payer: Multiplan PHCS |
$623.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.81
|
| Rate for Payer: UHCCP Medicaid |
$74.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.01
|
|
|
EXAM OF CERVIX W/SCOPE
|
Facility
|
IP
|
$1,039.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
76102193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.70 |
| Max. Negotiated Rate |
$997.44 |
| Rate for Payer: Aetna Commercial |
$800.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$810.42
|
| Rate for Payer: Cash Price |
$519.50
|
| Rate for Payer: Cigna Commercial |
$862.37
|
| Rate for Payer: First Health Commercial |
$987.05
|
| Rate for Payer: Humana Commercial |
$883.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$851.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$766.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$914.32
|
| Rate for Payer: Ohio Health Group HMO |
$779.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$716.91
|
| Rate for Payer: PHCS Commercial |
$997.44
|
| Rate for Payer: United Healthcare All Payer |
$914.32
|
|
