|
EXC BRST MASS MAL/FEM(T
|
Facility
|
OP
|
$6,377.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
761T0288
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,193.05 |
| Max. Negotiated Rate |
$6,121.92 |
| Rate for Payer: Aetna Commercial |
$4,910.29
|
| Rate for Payer: Anthem Medicaid |
$2,193.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,974.06
|
| 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 |
$3,188.50
|
| Rate for Payer: Cash Price |
$3,188.50
|
| Rate for Payer: Cigna Commercial |
$5,292.91
|
| Rate for Payer: First Health Commercial |
$6,058.15
|
| Rate for Payer: Humana Commercial |
$5,420.45
|
| Rate for Payer: Humana KY Medicaid |
$2,193.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,215.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,229.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,706.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,237.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,611.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,782.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,547.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,400.13
|
| Rate for Payer: PHCS Commercial |
$6,121.92
|
| Rate for Payer: United Healthcare All Payer |
$5,611.76
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Professional
|
Both
|
$4,036.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$98.03 |
| Max. Negotiated Rate |
$2,421.60 |
| Rate for Payer: Aetna Commercial |
$172.87
|
| Rate for Payer: Ambetter Exchange |
$98.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.64
|
| Rate for Payer: Cash Price |
$2,018.00
|
| Rate for Payer: Cash Price |
$2,018.00
|
| Rate for Payer: Cigna Commercial |
$160.13
|
| Rate for Payer: Healthspan PPO |
$125.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.03
|
| Rate for Payer: Multiplan PHCS |
$2,421.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.44
|
| Rate for Payer: UHCCP Medicaid |
$1,412.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.03
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
720P0006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$98.03 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$172.87
|
| Rate for Payer: Ambetter Exchange |
$98.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.64
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$160.13
|
| Rate for Payer: Healthspan PPO |
$125.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$126.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.03
|
| Rate for Payer: Multiplan PHCS |
$183.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.44
|
| Rate for Payer: UHCCP Medicaid |
$106.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.03
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
720T0006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Facility
|
IP
|
$4,036.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,210.80 |
| Max. Negotiated Rate |
$3,874.56 |
| Rate for Payer: Aetna Commercial |
$3,107.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.08
|
| Rate for Payer: Cash Price |
$2,018.00
|
| Rate for Payer: Cigna Commercial |
$3,349.88
|
| Rate for Payer: First Health Commercial |
$3,834.20
|
| Rate for Payer: Humana Commercial |
$3,430.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.84
|
| Rate for Payer: PHCS Commercial |
$3,874.56
|
| Rate for Payer: United Healthcare All Payer |
$3,551.68
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
720T0006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EX CEPH VERS W OR W/O TOCOLYSI
|
Facility
|
OP
|
$4,036.00
|
|
|
Service Code
|
HCPCS 59412
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,387.98 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$3,107.72
|
| Rate for Payer: Anthem Medicaid |
$1,387.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,018.00
|
| Rate for Payer: Cash Price |
$2,018.00
|
| Rate for Payer: Cigna Commercial |
$3,349.88
|
| Rate for Payer: First Health Commercial |
$3,834.20
|
| Rate for Payer: Humana Commercial |
$3,430.60
|
| Rate for Payer: Humana KY Medicaid |
$1,387.98
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.84
|
| Rate for Payer: PHCS Commercial |
$3,874.56
|
| Rate for Payer: United Healthcare All Payer |
$3,551.68
|
|
|
EXC. EXCESSIVE SKIN ABD.
|
Facility
|
IP
|
$15,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,739.09 |
| Max. Negotiated Rate |
$15,165.08 |
| Rate for Payer: Aetna Commercial |
$12,163.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,321.63
|
| Rate for Payer: Cash Price |
$7,898.48
|
| Rate for Payer: Cigna Commercial |
$13,111.48
|
| Rate for Payer: First Health Commercial |
$15,007.11
|
| Rate for Payer: Humana Commercial |
$13,427.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,953.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,658.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,739.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,901.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,847.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,637.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,743.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,899.90
|
| Rate for Payer: PHCS Commercial |
$15,165.08
|
| Rate for Payer: United Healthcare All Payer |
$13,901.32
|
|
|
EXC. EXCESSIVE SKIN ABD.
|
Facility
|
OP
|
$15,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,432.57 |
| Max. Negotiated Rate |
$15,165.08 |
| Rate for Payer: Aetna Commercial |
$12,163.66
|
| Rate for Payer: Anthem Medicaid |
$5,432.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,321.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Cash Price |
$7,898.48
|
| Rate for Payer: Cash Price |
$7,898.48
|
| Rate for Payer: Cigna Commercial |
$13,111.48
|
| Rate for Payer: First Health Commercial |
$15,007.11
|
| Rate for Payer: Humana Commercial |
$13,427.42
|
| Rate for Payer: Humana KY Medicaid |
$5,432.57
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Kentucky WC Medicaid |
$5,487.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,953.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,658.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,901.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,847.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,637.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,743.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,899.90
|
| Rate for Payer: PHCS Commercial |
$15,165.08
|
| Rate for Payer: United Healthcare All Payer |
$13,901.32
|
|
|
EXC. EXCESSIVE SKIN ABD.
|
Professional
|
Both
|
$15,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.54 |
| Max. Negotiated Rate |
$9,478.18 |
| Rate for Payer: Aetna Commercial |
$1,726.32
|
| Rate for Payer: Ambetter Exchange |
$1,111.23
|
| Rate for Payer: Anthem Medicaid |
$818.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,111.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,111.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,333.48
|
| Rate for Payer: Cash Price |
$7,898.48
|
| Rate for Payer: Cash Price |
$7,898.48
|
| Rate for Payer: Cigna Commercial |
$1,623.16
|
| Rate for Payer: Healthspan PPO |
$1,380.35
|
| Rate for Payer: Humana Medicaid |
$818.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,462.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,111.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,111.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$834.91
|
| Rate for Payer: Molina Healthcare Passport |
$818.54
|
| Rate for Payer: Multiplan PHCS |
$9,478.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,444.60
|
| Rate for Payer: UHCCP Medicaid |
$5,528.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$826.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,111.23
|
|
|
EXC. EXCESSIVE SKIN ABD.(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761P0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$818.54 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,726.32
|
| Rate for Payer: Ambetter Exchange |
$1,111.23
|
| Rate for Payer: Anthem Medicaid |
$818.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,111.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,111.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,333.48
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,623.16
|
| Rate for Payer: Healthspan PPO |
$1,380.35
|
| Rate for Payer: Humana Medicaid |
$818.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,462.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,111.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,111.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$834.91
|
| Rate for Payer: Molina Healthcare Passport |
$818.54
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,444.60
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$826.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,111.23
|
|
|
EXC. EXCESSIVE SKIN ABD.(T
|
Facility
|
IP
|
$12,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761T0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,839.09 |
| Max. Negotiated Rate |
$12,285.08 |
| Rate for Payer: Aetna Commercial |
$9,853.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.63
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cigna Commercial |
$10,621.48
|
| Rate for Payer: First Health Commercial |
$12,157.11
|
| Rate for Payer: Humana Commercial |
$10,877.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,839.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,597.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,829.90
|
| Rate for Payer: PHCS Commercial |
$12,285.08
|
| Rate for Payer: United Healthcare All Payer |
$11,261.32
|
|
|
EXC. EXCESSIVE SKIN ABD.(T
|
Facility
|
OP
|
$12,796.96
|
|
|
Service Code
|
HCPCS 15830
|
| Hospital Charge Code |
761T0219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,400.87 |
| Max. Negotiated Rate |
$12,285.08 |
| Rate for Payer: Aetna Commercial |
$9,853.66
|
| Rate for Payer: Anthem Medicaid |
$4,400.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,981.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cash Price |
$6,398.48
|
| Rate for Payer: Cigna Commercial |
$10,621.48
|
| Rate for Payer: First Health Commercial |
$12,157.11
|
| Rate for Payer: Humana Commercial |
$10,877.42
|
| Rate for Payer: Humana KY Medicaid |
$4,400.87
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Kentucky WC Medicaid |
$4,445.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,493.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,444.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,489.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,261.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,597.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,237.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,133.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,829.90
|
| Rate for Payer: PHCS Commercial |
$12,285.08
|
| Rate for Payer: United Healthcare All Payer |
$11,261.32
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
IP
|
$6,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761T0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,894.63 |
| Max. Negotiated Rate |
$6,062.80 |
| Rate for Payer: Aetna Commercial |
$4,862.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,926.03
|
| Rate for Payer: Cash Price |
$3,157.71
|
| Rate for Payer: Cigna Commercial |
$5,241.80
|
| Rate for Payer: First Health Commercial |
$5,999.65
|
| Rate for Payer: Humana Commercial |
$5,368.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,178.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,660.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,894.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,557.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,736.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,052.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,494.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,357.64
|
| Rate for Payer: PHCS Commercial |
$6,062.80
|
| Rate for Payer: United Healthcare All Payer |
$5,557.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
OP
|
$6,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761T0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,894.63 |
| Max. Negotiated Rate |
$6,062.80 |
| Rate for Payer: Aetna Commercial |
$4,862.87
|
| Rate for Payer: Anthem Medicaid |
$2,171.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,926.03
|
| Rate for Payer: Cash Price |
$3,157.71
|
| Rate for Payer: Cigna Commercial |
$5,241.80
|
| Rate for Payer: First Health Commercial |
$5,999.65
|
| Rate for Payer: Humana Commercial |
$5,368.11
|
| Rate for Payer: Humana KY Medicaid |
$2,171.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,193.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,178.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,660.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,894.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,215.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,557.57
|
| Rate for Payer: Ohio Health Group HMO |
$4,736.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,052.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,494.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,357.64
|
| Rate for Payer: PHCS Commercial |
$6,062.80
|
| Rate for Payer: United Healthcare All Payer |
$5,557.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
761P0224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$647.20
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.02
|
| 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
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Professional
|
Both
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5,820.79 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$647.20
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.02
|
| Rate for Payer: Multiplan PHCS |
$4,989.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,820.79
|
| Rate for Payer: UHCCP Medicaid |
$2,910.40
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
OP
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,494.63 |
| Max. Negotiated Rate |
$7,982.80 |
| Rate for Payer: Aetna Commercial |
$6,402.87
|
| Rate for Payer: Anthem Medicaid |
$2,859.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,486.03
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$6,901.80
|
| Rate for Payer: First Health Commercial |
$7,899.65
|
| Rate for Payer: Humana Commercial |
$7,068.11
|
| Rate for Payer: Humana KY Medicaid |
$2,859.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,888.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,818.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,136.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,494.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,317.57
|
| Rate for Payer: Ohio Health Group HMO |
$6,236.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,652.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,234.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,737.64
|
| Rate for Payer: PHCS Commercial |
$7,982.80
|
| Rate for Payer: United Healthcare All Payer |
$7,317.57
|
|
|
EXC EXCESSIVE SKIN & TISS. ABD
|
Facility
|
IP
|
$8,315.42
|
|
|
Service Code
|
HCPCS 15847
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,494.63 |
| Max. Negotiated Rate |
$7,982.80 |
| Rate for Payer: Aetna Commercial |
$6,402.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,486.03
|
| Rate for Payer: Cash Price |
$4,157.71
|
| Rate for Payer: Cigna Commercial |
$6,901.80
|
| Rate for Payer: First Health Commercial |
$7,899.65
|
| Rate for Payer: Humana Commercial |
$7,068.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,818.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,136.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,494.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,317.57
|
| Rate for Payer: Ohio Health Group HMO |
$6,236.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,652.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,234.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,737.64
|
| Rate for Payer: PHCS Commercial |
$7,982.80
|
| Rate for Payer: United Healthcare All Payer |
$7,317.57
|
|
|
EXC EXT HEMORRHOID TAGS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$329.91 |
| Rate for Payer: Aetna Commercial |
$243.13
|
| Rate for Payer: Ambetter Exchange |
$165.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.24
|
| Rate for Payer: Anthem Medicaid |
$99.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.43
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Healthspan PPO |
$297.11
|
| Rate for Payer: Humana Medicaid |
$99.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.10
|
| Rate for Payer: Molina Healthcare Passport |
$99.12
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.97
|
| Rate for Payer: UHCCP Medicaid |
$113.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.36
|
|
|
EXC EXT HEMORRHOID TAGS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXC EXT HEMORRHOID TAGS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
76101918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
EXC EXT HEMORRHOID TAGS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46230
|
| Hospital Charge Code |
761P1918
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$329.91 |
| Rate for Payer: Aetna Commercial |
$243.13
|
| Rate for Payer: Ambetter Exchange |
$165.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.24
|
| Rate for Payer: Anthem Medicaid |
$99.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.43
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$329.91
|
| Rate for Payer: Healthspan PPO |
$297.11
|
| Rate for Payer: Humana Medicaid |
$99.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$165.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.10
|
| Rate for Payer: Molina Healthcare Passport |
$99.12
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.97
|
| Rate for Payer: UHCCP Medicaid |
$113.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.36
|
|
|
EXC FACE LES SC < 2 CM
|
Facility
|
OP
|
$5,414.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem Medicaid |
$1,861.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$4,493.62
|
| Rate for Payer: First Health Commercial |
$5,143.30
|
| Rate for Payer: Humana Commercial |
$4,601.90
|
| Rate for Payer: Humana KY Medicaid |
$1,861.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,880.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,439.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,995.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,899.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,764.32
|
| Rate for Payer: Ohio Health Group HMO |
$4,060.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,710.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,735.66
|
| Rate for Payer: PHCS Commercial |
$5,197.44
|
| Rate for Payer: United Healthcare All Payer |
$4,764.32
|
|
|
EXC FACE LES SC < 2 CM
|
Professional
|
Both
|
$5,414.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.54 |
| Max. Negotiated Rate |
$3,248.40 |
| Rate for Payer: Aetna Commercial |
$372.59
|
| Rate for Payer: Ambetter Exchange |
$247.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$132.54
|
| Rate for Payer: Anthem Medicaid |
$224.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.44
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cash Price |
$2,707.00
|
| Rate for Payer: Cigna Commercial |
$542.96
|
| Rate for Payer: Healthspan PPO |
$336.12
|
| Rate for Payer: Humana Medicaid |
$224.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$310.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.82
|
| Rate for Payer: Molina Healthcare Passport |
$224.33
|
| Rate for Payer: Multiplan PHCS |
$3,248.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.14
|
| Rate for Payer: UHCCP Medicaid |
$139.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.03
|
|
