|
EXAM OF CERVIX W/SCOPE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761P2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.89 |
| Max. Negotiated Rate |
$300.00 |
| 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 |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| 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 |
$300.00
|
| 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(T
|
Facility
|
IP
|
$539.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761T2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$517.44 |
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.42
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna Commercial |
$447.37
|
| Rate for Payer: First Health Commercial |
$512.05
|
| Rate for Payer: Humana Commercial |
$458.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$441.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$397.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.32
|
| Rate for Payer: Ohio Health Group HMO |
$404.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.91
|
| Rate for Payer: PHCS Commercial |
$517.44
|
| Rate for Payer: United Healthcare All Payer |
$474.32
|
|
|
EXAM OF CERVIX W/SCOPE(T
|
Facility
|
OP
|
$539.00
|
|
|
Service Code
|
HCPCS 57452
|
| Hospital Charge Code |
761T2193
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.36 |
| Max. Negotiated Rate |
$517.44 |
| Rate for Payer: Aetna Commercial |
$415.03
|
| Rate for Payer: Anthem Medicaid |
$185.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$420.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cigna Commercial |
$447.37
|
| Rate for Payer: First Health Commercial |
$512.05
|
| Rate for Payer: Humana Commercial |
$458.15
|
| Rate for Payer: Humana KY Medicaid |
$185.36
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$187.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$441.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$397.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$474.32
|
| Rate for Payer: Ohio Health Group HMO |
$404.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.91
|
| Rate for Payer: PHCS Commercial |
$517.44
|
| Rate for Payer: United Healthcare All Payer |
$474.32
|
|
|
EXAM OF VAGINA W/SCOPE
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.46 |
| Max. Negotiated Rate |
$711.00 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Ambetter Exchange |
$85.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.46
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.64
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$172.97
|
| Rate for Payer: Healthspan PPO |
$168.86
|
| Rate for Payer: Humana Medicaid |
$91.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.66
|
| Rate for Payer: Molina Healthcare Passport |
$91.82
|
| Rate for Payer: Multiplan PHCS |
$711.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.19
|
| Rate for Payer: UHCCP Medicaid |
$66.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.53
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem Medicaid |
$407.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Humana KY Medicaid |
$407.52
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$411.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
EXAM OF VAGINA W/SCOPE
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
76102192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$1,137.60 |
| Rate for Payer: Aetna Commercial |
$912.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.30
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$983.55
|
| Rate for Payer: First Health Commercial |
$1,125.75
|
| Rate for Payer: Humana Commercial |
$1,007.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.80
|
| Rate for Payer: Ohio Health Group HMO |
$888.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.65
|
| Rate for Payer: PHCS Commercial |
$1,137.60
|
| Rate for Payer: United Healthcare All Payer |
$1,042.80
|
|
|
EXAM OF VAGINA W/SCOPE(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761P2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.46 |
| Max. Negotiated Rate |
$172.97 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Ambetter Exchange |
$85.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.46
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.64
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$172.97
|
| Rate for Payer: Healthspan PPO |
$168.86
|
| Rate for Payer: Humana Medicaid |
$91.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$117.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.66
|
| Rate for Payer: Molina Healthcare Passport |
$91.82
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$111.19
|
| Rate for Payer: UHCCP Medicaid |
$66.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.53
|
|
|
EXAM OF VAGINA W/SCOPE(T
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761T2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
EXAM OF VAGINA W/SCOPE(T
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 57420
|
| Hospital Charge Code |
761T2192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.07 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$281.07
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Professional
|
Both
|
$7,390.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.58 |
| Max. Negotiated Rate |
$4,434.00 |
| Rate for Payer: Aetna Commercial |
$1,070.69
|
| Rate for Payer: Ambetter Exchange |
$662.13
|
| Rate for Payer: Anthem Medicaid |
$503.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$662.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$662.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$794.56
|
| Rate for Payer: Cash Price |
$3,695.00
|
| Rate for Payer: Cash Price |
$3,695.00
|
| Rate for Payer: Cigna Commercial |
$1,219.02
|
| Rate for Payer: Healthspan PPO |
$763.51
|
| Rate for Payer: Humana Medicaid |
$503.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$883.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$662.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.65
|
| Rate for Payer: Molina Healthcare Passport |
$503.58
|
| Rate for Payer: Multiplan PHCS |
$4,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$860.77
|
| Rate for Payer: UHCCP Medicaid |
$2,586.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$662.13
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Facility
|
IP
|
$7,390.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,217.00 |
| Max. Negotiated Rate |
$7,094.40 |
| Rate for Payer: Aetna Commercial |
$5,690.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.20
|
| Rate for Payer: Cash Price |
$3,695.00
|
| Rate for Payer: Cigna Commercial |
$6,133.70
|
| Rate for Payer: First Health Commercial |
$7,020.50
|
| Rate for Payer: Humana Commercial |
$6,281.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,429.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,099.10
|
| Rate for Payer: PHCS Commercial |
$7,094.40
|
| Rate for Payer: United Healthcare All Payer |
$6,503.20
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM
|
Facility
|
OP
|
$7,390.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,541.42 |
| Max. Negotiated Rate |
$7,094.40 |
| Rate for Payer: Aetna Commercial |
$5,690.30
|
| Rate for Payer: Anthem Medicaid |
$2,541.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,695.00
|
| Rate for Payer: Cash Price |
$3,695.00
|
| Rate for Payer: Cigna Commercial |
$6,133.70
|
| Rate for Payer: First Health Commercial |
$7,020.50
|
| Rate for Payer: Humana Commercial |
$6,281.50
|
| Rate for Payer: Humana KY Medicaid |
$2,541.42
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,429.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,099.10
|
| Rate for Payer: PHCS Commercial |
$7,094.40
|
| Rate for Payer: United Healthcare All Payer |
$6,503.20
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
761P0501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,219.02 |
| Rate for Payer: Aetna Commercial |
$1,070.69
|
| Rate for Payer: Ambetter Exchange |
$662.13
|
| Rate for Payer: Anthem Medicaid |
$503.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$662.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$662.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$794.56
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$1,219.02
|
| Rate for Payer: Healthspan PPO |
$763.51
|
| Rate for Payer: Humana Medicaid |
$503.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$883.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$662.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$513.65
|
| Rate for Payer: Molina Healthcare Passport |
$503.58
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$860.77
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$508.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$662.13
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM(T
|
Facility
|
OP
|
$6,390.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
761T0501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,197.52 |
| Max. Negotiated Rate |
$6,134.40 |
| Rate for Payer: Aetna Commercial |
$4,920.30
|
| Rate for Payer: Anthem Medicaid |
$2,197.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,984.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,195.00
|
| Rate for Payer: Cash Price |
$3,195.00
|
| Rate for Payer: Cigna Commercial |
$5,303.70
|
| Rate for Payer: First Health Commercial |
$6,070.50
|
| Rate for Payer: Humana Commercial |
$5,431.50
|
| Rate for Payer: Humana KY Medicaid |
$2,197.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,219.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,239.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,715.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,241.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,623.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,559.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,409.10
|
| Rate for Payer: PHCS Commercial |
$6,134.40
|
| Rate for Payer: United Healthcare All Payer |
$5,623.20
|
|
|
EX ARM/ELBOW TUM DEEP > 5 CM(T
|
Facility
|
IP
|
$6,390.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
761T0501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,917.00 |
| Max. Negotiated Rate |
$6,134.40 |
| Rate for Payer: Aetna Commercial |
$4,920.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,984.20
|
| Rate for Payer: Cash Price |
$3,195.00
|
| Rate for Payer: Cigna Commercial |
$5,303.70
|
| Rate for Payer: First Health Commercial |
$6,070.50
|
| Rate for Payer: Humana Commercial |
$5,431.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,239.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,715.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,917.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,623.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,559.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,409.10
|
| Rate for Payer: PHCS Commercial |
$6,134.40
|
| Rate for Payer: United Healthcare All Payer |
$5,623.20
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
761T0289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,357.20 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
OP
|
$5,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,899.70 |
| Max. Negotiated Rate |
$5,303.04 |
| Rate for Payer: Aetna Commercial |
$4,253.48
|
| Rate for Payer: Anthem Medicaid |
$1,899.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,308.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,762.00
|
| Rate for Payer: Cash Price |
$2,762.00
|
| Rate for Payer: Cigna Commercial |
$4,584.92
|
| Rate for Payer: First Health Commercial |
$5,247.80
|
| Rate for Payer: Humana Commercial |
$4,695.40
|
| Rate for Payer: Humana KY Medicaid |
$1,899.70
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,529.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,937.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,861.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,811.56
|
| Rate for Payer: PHCS Commercial |
$5,303.04
|
| Rate for Payer: United Healthcare All Payer |
$4,861.12
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
IP
|
$5,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,657.20 |
| Max. Negotiated Rate |
$5,303.04 |
| Rate for Payer: Aetna Commercial |
$4,253.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,308.72
|
| Rate for Payer: Cash Price |
$2,762.00
|
| Rate for Payer: Cigna Commercial |
$4,584.92
|
| Rate for Payer: First Health Commercial |
$5,247.80
|
| Rate for Payer: Humana Commercial |
$4,695.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,529.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,861.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,419.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,811.56
|
| Rate for Payer: PHCS Commercial |
$5,303.04
|
| Rate for Payer: United Healthcare All Payer |
$4,861.12
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
761T0289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem Medicaid |
$1,555.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Humana KY Medicaid |
$1,555.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Professional
|
Both
|
$5,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.61 |
| Max. Negotiated Rate |
$3,314.40 |
| Rate for Payer: Aetna Commercial |
$630.59
|
| Rate for Payer: Ambetter Exchange |
$441.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$238.61
|
| Rate for Payer: Anthem Medicaid |
$264.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$441.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$441.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$530.06
|
| Rate for Payer: Cash Price |
$2,762.00
|
| Rate for Payer: Cash Price |
$2,762.00
|
| Rate for Payer: Cigna Commercial |
$581.28
|
| Rate for Payer: Healthspan PPO |
$579.97
|
| Rate for Payer: Humana Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$441.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.30
|
| Rate for Payer: Molina Healthcare Passport |
$264.02
|
| Rate for Payer: Multiplan PHCS |
$3,314.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$574.24
|
| Rate for Payer: UHCCP Medicaid |
$250.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$441.72
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
45000085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem Medicaid |
$1,555.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Humana KY Medicaid |
$1,555.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
761P0289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.61 |
| Max. Negotiated Rate |
$630.59 |
| Rate for Payer: Aetna Commercial |
$630.59
|
| Rate for Payer: Ambetter Exchange |
$441.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$238.61
|
| Rate for Payer: Anthem Medicaid |
$264.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$441.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$441.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$530.06
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$581.28
|
| Rate for Payer: Healthspan PPO |
$579.97
|
| Rate for Payer: Humana Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$441.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$441.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$269.30
|
| Rate for Payer: Molina Healthcare Passport |
$264.02
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$574.24
|
| Rate for Payer: UHCCP Medicaid |
$250.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$266.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$441.72
|
|
|
EX BRS LESIONWPREOPMARKOPNSING
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
45000085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,357.20 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
EXC ABD LES SC 3 CM/>
|
Professional
|
Both
|
$6,065.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
76100430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.49 |
| Max. Negotiated Rate |
$3,639.00 |
| Rate for Payer: Aetna Commercial |
$675.66
|
| Rate for Payer: Ambetter Exchange |
$421.15
|
| Rate for Payer: Anthem Medicaid |
$318.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$421.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$505.38
|
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Cigna Commercial |
$770.20
|
| Rate for Payer: Healthspan PPO |
$481.50
|
| Rate for Payer: Humana Medicaid |
$318.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$559.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$421.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.86
|
| Rate for Payer: Molina Healthcare Passport |
$318.49
|
| Rate for Payer: Multiplan PHCS |
$3,639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$547.50
|
| Rate for Payer: UHCCP Medicaid |
$2,122.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$421.15
|
|
|
EXC ABD LES SC 3 CM/>
|
Facility
|
OP
|
$6,065.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
76100430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,085.75 |
| Max. Negotiated Rate |
$5,822.40 |
| Rate for Payer: Aetna Commercial |
$4,670.05
|
| Rate for Payer: Anthem Medicaid |
$2,085.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,730.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Cash Price |
$3,032.50
|
| Rate for Payer: Cigna Commercial |
$5,033.95
|
| Rate for Payer: First Health Commercial |
$5,761.75
|
| Rate for Payer: Humana Commercial |
$5,155.25
|
| Rate for Payer: Humana KY Medicaid |
$2,085.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,106.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,973.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,475.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,127.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,337.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,548.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,276.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,184.85
|
| Rate for Payer: PHCS Commercial |
$5,822.40
|
| Rate for Payer: United Healthcare All Payer |
$5,337.20
|
|
