|
EXC FACE LES SC < 2 CM
|
Facility
|
IP
|
$5,414.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
76100362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,624.20 |
| Max. Negotiated Rate |
$5,197.44 |
| Rate for Payer: Aetna Commercial |
$4,168.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,222.92
|
| 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: 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 |
$1,624.20
|
| 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
|
Facility
|
OP
|
$6,332.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$6,078.72 |
| Rate for Payer: Aetna Commercial |
$4,875.64
|
| Rate for Payer: Anthem Medicaid |
$2,177.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,938.96
|
| 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 |
$3,166.00
|
| Rate for Payer: Cash Price |
$3,166.00
|
| Rate for Payer: Cigna Commercial |
$5,255.56
|
| Rate for Payer: First Health Commercial |
$6,015.40
|
| Rate for Payer: Humana Commercial |
$5,382.20
|
| Rate for Payer: Humana KY Medicaid |
$2,177.57
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,199.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,192.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,673.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,221.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,572.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,749.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,508.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,369.08
|
| Rate for Payer: PHCS Commercial |
$6,078.72
|
| Rate for Payer: United Healthcare All Payer |
$5,572.16
|
|
|
EXC FACE LES SC = 2 CM
|
Facility
|
IP
|
$6,332.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,899.60 |
| Max. Negotiated Rate |
$6,078.72 |
| Rate for Payer: Aetna Commercial |
$4,875.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,938.96
|
| Rate for Payer: Cash Price |
$3,166.00
|
| Rate for Payer: Cigna Commercial |
$5,255.56
|
| Rate for Payer: First Health Commercial |
$6,015.40
|
| Rate for Payer: Humana Commercial |
$5,382.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,192.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,673.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,899.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,572.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,749.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,065.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,508.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,369.08
|
| Rate for Payer: PHCS Commercial |
$6,078.72
|
| Rate for Payer: United Healthcare All Payer |
$5,572.16
|
|
|
EXC FACE LES SC = 2 CM
|
Professional
|
Both
|
$6,332.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
76100363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$3,799.20 |
| Rate for Payer: Aetna Commercial |
$512.89
|
| Rate for Payer: Ambetter Exchange |
$321.90
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.28
|
| Rate for Payer: Cash Price |
$3,166.00
|
| Rate for Payer: Cash Price |
$3,166.00
|
| Rate for Payer: Cigna Commercial |
$587.11
|
| Rate for Payer: Healthspan PPO |
$365.49
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$321.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$3,799.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$418.47
|
| Rate for Payer: UHCCP Medicaid |
$2,216.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.90
|
|
|
EXC FACE LES SC < 2 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761P0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.54 |
| Max. Negotiated Rate |
$600.00 |
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| 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 |
$600.00
|
| 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
|
|
|
EXC FACE LES SC = 2 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761P0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$512.89
|
| Rate for Payer: Ambetter Exchange |
$321.90
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.28
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$587.11
|
| Rate for Payer: Healthspan PPO |
$365.49
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$430.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$321.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$418.47
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.90
|
|
|
EXC FACE LES SC < 2 CM(T
|
Facility
|
OP
|
$4,414.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761T0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,237.44 |
| Rate for Payer: Aetna Commercial |
$3,398.78
|
| Rate for Payer: Anthem Medicaid |
$1,517.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.92
|
| 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 |
$2,207.00
|
| Rate for Payer: Cash Price |
$2,207.00
|
| Rate for Payer: Cigna Commercial |
$3,663.62
|
| Rate for Payer: First Health Commercial |
$4,193.30
|
| Rate for Payer: Humana Commercial |
$3,751.90
|
| Rate for Payer: Humana KY Medicaid |
$1,517.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.66
|
| Rate for Payer: PHCS Commercial |
$4,237.44
|
| Rate for Payer: United Healthcare All Payer |
$3,884.32
|
|
|
EXC FACE LES SC < 2 CM(T
|
Facility
|
IP
|
$4,414.00
|
|
|
Service Code
|
HCPCS 21011
|
| Hospital Charge Code |
761T0362
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,324.20 |
| Max. Negotiated Rate |
$4,237.44 |
| Rate for Payer: Aetna Commercial |
$3,398.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.92
|
| Rate for Payer: Cash Price |
$2,207.00
|
| Rate for Payer: Cigna Commercial |
$3,663.62
|
| Rate for Payer: First Health Commercial |
$4,193.30
|
| Rate for Payer: Humana Commercial |
$3,751.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.66
|
| Rate for Payer: PHCS Commercial |
$4,237.44
|
| Rate for Payer: United Healthcare All Payer |
$3,884.32
|
|
|
EXC FACE LES SC = 2 CM(T
|
Facility
|
IP
|
$5,332.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761T0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,599.60 |
| Max. Negotiated Rate |
$5,118.72 |
| Rate for Payer: Aetna Commercial |
$4,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,158.96
|
| Rate for Payer: Cash Price |
$2,666.00
|
| Rate for Payer: Cigna Commercial |
$4,425.56
|
| Rate for Payer: First Health Commercial |
$5,065.40
|
| Rate for Payer: Humana Commercial |
$4,532.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,638.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,679.08
|
| Rate for Payer: PHCS Commercial |
$5,118.72
|
| Rate for Payer: United Healthcare All Payer |
$4,692.16
|
|
|
EXC FACE LES SC = 2 CM(T
|
Facility
|
OP
|
$5,332.00
|
|
|
Service Code
|
HCPCS 21012
|
| Hospital Charge Code |
761T0363
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,118.72 |
| Rate for Payer: Aetna Commercial |
$4,105.64
|
| Rate for Payer: Anthem Medicaid |
$1,833.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,158.96
|
| 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 |
$2,666.00
|
| Rate for Payer: Cash Price |
$2,666.00
|
| Rate for Payer: Cigna Commercial |
$4,425.56
|
| Rate for Payer: First Health Commercial |
$5,065.40
|
| Rate for Payer: Humana Commercial |
$4,532.20
|
| Rate for Payer: Humana KY Medicaid |
$1,833.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,638.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,679.08
|
| Rate for Payer: PHCS Commercial |
$5,118.72
|
| Rate for Payer: United Healthcare All Payer |
$4,692.16
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
IP
|
$2,884.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$865.20 |
| Max. Negotiated Rate |
$2,768.64 |
| Rate for Payer: Aetna Commercial |
$2,220.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,249.52
|
| Rate for Payer: Cash Price |
$1,442.00
|
| Rate for Payer: Cigna Commercial |
$2,393.72
|
| Rate for Payer: First Health Commercial |
$2,739.80
|
| Rate for Payer: Humana Commercial |
$2,451.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,364.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,128.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,537.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,163.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,509.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,989.96
|
| Rate for Payer: PHCS Commercial |
$2,768.64
|
| Rate for Payer: United Healthcare All Payer |
$2,537.92
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
OP
|
$2,884.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$991.81 |
| Max. Negotiated Rate |
$2,768.64 |
| Rate for Payer: Aetna Commercial |
$2,220.68
|
| Rate for Payer: Anthem Medicaid |
$991.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,249.52
|
| 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 |
$1,442.00
|
| Rate for Payer: Cash Price |
$1,442.00
|
| Rate for Payer: Cigna Commercial |
$2,393.72
|
| Rate for Payer: First Health Commercial |
$2,739.80
|
| Rate for Payer: Humana Commercial |
$2,451.40
|
| Rate for Payer: Humana KY Medicaid |
$991.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,001.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,364.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,128.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,011.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,537.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,163.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,509.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,989.96
|
| Rate for Payer: PHCS Commercial |
$2,768.64
|
| Rate for Payer: United Healthcare All Payer |
$2,537.92
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Professional
|
Both
|
$2,884.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$1,730.40 |
| Rate for Payer: Aetna Commercial |
$319.92
|
| Rate for Payer: Ambetter Exchange |
$214.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$141.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$214.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$214.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$256.93
|
| Rate for Payer: Cash Price |
$1,442.00
|
| Rate for Payer: Cash Price |
$1,442.00
|
| Rate for Payer: Cigna Commercial |
$373.26
|
| Rate for Payer: Healthspan PPO |
$307.60
|
| Rate for Payer: Humana Medicaid |
$141.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$214.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.55
|
| Rate for Payer: Molina Healthcare Passport |
$141.72
|
| Rate for Payer: Multiplan PHCS |
$1,730.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.34
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$214.11
|
|
|
EXC FACE-MM B9+MARG 3.1-4 CM
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.08 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem Medicaid |
$751.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| 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 |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Humana KY Medicaid |
$751.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXC FACE-MM B9+MARG 3.1-4 C(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
761P0067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$319.92
|
| Rate for Payer: Ambetter Exchange |
$214.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$141.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$214.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$214.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$256.93
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$373.26
|
| Rate for Payer: Healthspan PPO |
$307.60
|
| Rate for Payer: Humana Medicaid |
$141.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$214.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.55
|
| Rate for Payer: Molina Healthcare Passport |
$141.72
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$278.34
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$214.11
|
|
|
EXC FACE-MM B9+MARG 3.1-4 C(T
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
761T0067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$655.20 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXC FACE-MM B9+MARG 3.1-4 C(T
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
761T0067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$751.08 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem Medicaid |
$751.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| 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 |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Humana KY Medicaid |
$751.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.96
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Professional
|
Both
|
$6,078.00
|
|
|
Service Code
|
HCPCS 21013
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.74 |
| Max. Negotiated Rate |
$3,646.80 |
| Rate for Payer: Aetna Commercial |
$603.32
|
| Rate for Payer: Ambetter Exchange |
$379.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.74
|
| Rate for Payer: Anthem Medicaid |
$350.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$379.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$379.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$455.69
|
| Rate for Payer: Cash Price |
$3,039.00
|
| Rate for Payer: Cash Price |
$3,039.00
|
| Rate for Payer: Cigna Commercial |
$846.47
|
| Rate for Payer: Healthspan PPO |
$525.47
|
| Rate for Payer: Humana Medicaid |
$350.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$379.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.25
|
| Rate for Payer: Molina Healthcare Passport |
$350.25
|
| Rate for Payer: Multiplan PHCS |
$3,646.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$493.66
|
| Rate for Payer: UHCCP Medicaid |
$216.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$379.74
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
OP
|
$6,078.00
|
|
|
Service Code
|
HCPCS 21013
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,834.88 |
| Rate for Payer: Aetna Commercial |
$4,680.06
|
| Rate for Payer: Anthem Medicaid |
$2,090.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,740.84
|
| 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 |
$3,039.00
|
| Rate for Payer: Cash Price |
$3,039.00
|
| Rate for Payer: Cigna Commercial |
$5,044.74
|
| Rate for Payer: First Health Commercial |
$5,774.10
|
| Rate for Payer: Humana Commercial |
$5,166.30
|
| Rate for Payer: Humana KY Medicaid |
$2,090.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,983.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,485.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,132.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,348.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,287.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,193.82
|
| Rate for Payer: PHCS Commercial |
$5,834.88
|
| Rate for Payer: United Healthcare All Payer |
$5,348.64
|
|
|
EXC FACE TUM DEEP < 2 CM
|
Facility
|
IP
|
$6,078.00
|
|
|
Service Code
|
HCPCS 21013
|
| Hospital Charge Code |
76100364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,823.40 |
| Max. Negotiated Rate |
$5,834.88 |
| Rate for Payer: Aetna Commercial |
$4,680.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,740.84
|
| Rate for Payer: Cash Price |
$3,039.00
|
| Rate for Payer: Cigna Commercial |
$5,044.74
|
| Rate for Payer: First Health Commercial |
$5,774.10
|
| Rate for Payer: Humana Commercial |
$5,166.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,983.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,485.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,823.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,348.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,862.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,287.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,193.82
|
| Rate for Payer: PHCS Commercial |
$5,834.88
|
| Rate for Payer: United Healthcare All Payer |
$5,348.64
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Professional
|
Both
|
$6,542.00
|
|
|
Service Code
|
HCPCS 21014
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.05 |
| Max. Negotiated Rate |
$3,925.20 |
| Rate for Payer: Aetna Commercial |
$792.73
|
| Rate for Payer: Ambetter Exchange |
$494.06
|
| Rate for Payer: Anthem Medicaid |
$376.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$494.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$494.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$592.87
|
| Rate for Payer: Cash Price |
$3,271.00
|
| Rate for Payer: Cash Price |
$3,271.00
|
| Rate for Payer: Cigna Commercial |
$907.38
|
| Rate for Payer: Healthspan PPO |
$565.43
|
| Rate for Payer: Humana Medicaid |
$376.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$665.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$494.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$494.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$383.57
|
| Rate for Payer: Molina Healthcare Passport |
$376.05
|
| Rate for Payer: Multiplan PHCS |
$3,925.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$642.28
|
| Rate for Payer: UHCCP Medicaid |
$2,289.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$379.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$494.06
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
IP
|
$6,542.00
|
|
|
Service Code
|
HCPCS 21014
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,962.60 |
| Max. Negotiated Rate |
$6,280.32 |
| Rate for Payer: Aetna Commercial |
$5,037.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,102.76
|
| Rate for Payer: Cash Price |
$3,271.00
|
| Rate for Payer: Cigna Commercial |
$5,429.86
|
| Rate for Payer: First Health Commercial |
$6,214.90
|
| Rate for Payer: Humana Commercial |
$5,560.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,364.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,828.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,962.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,756.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,906.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,691.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,513.98
|
| Rate for Payer: PHCS Commercial |
$6,280.32
|
| Rate for Payer: United Healthcare All Payer |
$5,756.96
|
|
|
EXC FACE TUM DEEP 2 CM/>
|
Facility
|
OP
|
$6,542.00
|
|
|
Service Code
|
HCPCS 21014
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,249.79 |
| Max. Negotiated Rate |
$6,280.32 |
| Rate for Payer: Aetna Commercial |
$5,037.34
|
| Rate for Payer: Anthem Medicaid |
$2,249.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,102.76
|
| 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 |
$3,271.00
|
| Rate for Payer: Cash Price |
$3,271.00
|
| Rate for Payer: Cigna Commercial |
$5,429.86
|
| Rate for Payer: First Health Commercial |
$6,214.90
|
| Rate for Payer: Humana Commercial |
$5,560.70
|
| Rate for Payer: Humana KY Medicaid |
$2,249.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,272.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,364.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,828.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,294.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,756.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,906.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,691.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,513.98
|
| Rate for Payer: PHCS Commercial |
$6,280.32
|
| Rate for Payer: United Healthcare All Payer |
$5,756.96
|
|
|
EXC FACE TUM DEEP < 2 CM(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 21013
|
| Hospital Charge Code |
761P0364
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.74 |
| Max. Negotiated Rate |
$846.47 |
| Rate for Payer: Aetna Commercial |
$603.32
|
| Rate for Payer: Ambetter Exchange |
$379.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.74
|
| Rate for Payer: Anthem Medicaid |
$350.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$379.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$379.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$455.69
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$846.47
|
| Rate for Payer: Healthspan PPO |
$525.47
|
| Rate for Payer: Humana Medicaid |
$350.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$501.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$379.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.25
|
| Rate for Payer: Molina Healthcare Passport |
$350.25
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$493.66
|
| Rate for Payer: UHCCP Medicaid |
$216.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$379.74
|
|
