|
EXC HDRDNTS INGU SMPL/INT RPR
|
Facility
|
IP
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,959.90 |
| Max. Negotiated Rate |
$6,271.68 |
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,959.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,683.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,507.77
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
|
|
EXC HDRDNTS INGU SMPL/INT RPR
|
Facility
|
OP
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,246.70 |
| Max. Negotiated Rate |
$6,271.68 |
| Rate for Payer: Aetna Commercial |
$5,030.41
|
| Rate for Payer: Anthem Medicaid |
$2,246.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,095.74
|
| 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 |
$3,266.50
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$5,422.39
|
| Rate for Payer: First Health Commercial |
$6,206.35
|
| Rate for Payer: Humana Commercial |
$5,553.05
|
| Rate for Payer: Humana KY Medicaid |
$2,246.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,269.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,821.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,291.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,749.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,899.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,226.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,683.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,507.77
|
| Rate for Payer: PHCS Commercial |
$6,271.68
|
| Rate for Payer: United Healthcare All Payer |
$5,749.04
|
|
|
EXC HDRDNTS INGU SMPL/INT RPR
|
Professional
|
Both
|
$6,533.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$3,919.80 |
| Rate for Payer: Aetna Commercial |
$317.67
|
| Rate for Payer: Ambetter Exchange |
$237.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.15
|
| Rate for Payer: Anthem Medicaid |
$142.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$237.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.42
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cash Price |
$3,266.50
|
| Rate for Payer: Cigna Commercial |
$290.86
|
| Rate for Payer: Healthspan PPO |
$376.40
|
| Rate for Payer: Humana Medicaid |
$142.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$237.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.49
|
| Rate for Payer: Molina Healthcare Passport |
$142.64
|
| Rate for Payer: Multiplan PHCS |
$3,919.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.20
|
| Rate for Payer: UHCCP Medicaid |
$137.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.85
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(T
|
Facility
|
OP
|
$5,673.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761T0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,950.94 |
| Max. Negotiated Rate |
$5,446.08 |
| Rate for Payer: Aetna Commercial |
$4,368.21
|
| Rate for Payer: Anthem Medicaid |
$1,950.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.94
|
| 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 |
$2,836.50
|
| Rate for Payer: Cash Price |
$2,836.50
|
| Rate for Payer: Cigna Commercial |
$4,708.59
|
| Rate for Payer: First Health Commercial |
$5,389.35
|
| Rate for Payer: Humana Commercial |
$4,822.05
|
| Rate for Payer: Humana KY Medicaid |
$1,950.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,970.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,186.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,990.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,992.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,935.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,914.37
|
| Rate for Payer: PHCS Commercial |
$5,446.08
|
| Rate for Payer: United Healthcare All Payer |
$4,992.24
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(T
|
Facility
|
IP
|
$5,673.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761T0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,701.90 |
| Max. Negotiated Rate |
$5,446.08 |
| Rate for Payer: Aetna Commercial |
$4,368.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.94
|
| Rate for Payer: Cash Price |
$2,836.50
|
| Rate for Payer: Cigna Commercial |
$4,708.59
|
| Rate for Payer: First Health Commercial |
$5,389.35
|
| Rate for Payer: Humana Commercial |
$4,822.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,186.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,992.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,538.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,935.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,914.37
|
| Rate for Payer: PHCS Commercial |
$5,446.08
|
| Rate for Payer: United Healthcare All Payer |
$4,992.24
|
|
|
EXC HEMRHD TAG
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna Commercial |
$161.12
|
| Rate for Payer: Ambetter Exchange |
$114.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.98
|
| Rate for Payer: Anthem Medicaid |
$64.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.77
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$229.14
|
| Rate for Payer: Healthspan PPO |
$214.41
|
| Rate for Payer: Humana Medicaid |
$64.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.40
|
| Rate for Payer: Molina Healthcare Passport |
$64.12
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$149.25
|
| Rate for Payer: UHCCP Medicaid |
$68.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.81
|
|
|
EXC HEMRHD TAG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.36 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXC HEMRHD TAG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
76101916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EXC HEMRHD TAG(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46220
|
| Hospital Charge Code |
761P1916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna Commercial |
$161.12
|
| Rate for Payer: Ambetter Exchange |
$114.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.98
|
| Rate for Payer: Anthem Medicaid |
$64.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$114.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$114.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$137.77
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$229.14
|
| Rate for Payer: Healthspan PPO |
$214.41
|
| Rate for Payer: Humana Medicaid |
$64.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$147.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$114.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.40
|
| Rate for Payer: Molina Healthcare Passport |
$64.12
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$149.25
|
| Rate for Payer: UHCCP Medicaid |
$68.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$114.81
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Professional
|
Both
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.13 |
| Max. Negotiated Rate |
$4,248.65 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Ambetter Exchange |
$313.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.13
|
| Rate for Payer: Anthem Medicaid |
$173.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$375.91
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$413.66
|
| Rate for Payer: Healthspan PPO |
$516.54
|
| Rate for Payer: Humana Medicaid |
$173.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.88
|
| Rate for Payer: Molina Healthcare Passport |
$173.41
|
| Rate for Payer: Multiplan PHCS |
$4,248.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.24
|
| Rate for Payer: UHCCP Medicaid |
$179.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.26
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
OP
|
$6,031.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
761T0072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,074.09 |
| Max. Negotiated Rate |
$5,789.84 |
| Rate for Payer: Aetna Commercial |
$4,643.93
|
| Rate for Payer: Anthem Medicaid |
$2,074.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,704.24
|
| 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 |
$3,015.54
|
| Rate for Payer: Cash Price |
$3,015.54
|
| Rate for Payer: Cigna Commercial |
$5,005.80
|
| Rate for Payer: First Health Commercial |
$5,729.53
|
| Rate for Payer: Humana Commercial |
$5,126.42
|
| Rate for Payer: Humana KY Medicaid |
$2,074.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,095.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,945.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,115.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,307.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,523.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,824.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,247.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,161.45
|
| Rate for Payer: PHCS Commercial |
$5,789.84
|
| Rate for Payer: United Healthcare All Payer |
$5,307.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
IP
|
$6,031.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
761T0072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,809.32 |
| Max. Negotiated Rate |
$5,789.84 |
| Rate for Payer: Aetna Commercial |
$4,643.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,704.24
|
| Rate for Payer: Cash Price |
$3,015.54
|
| Rate for Payer: Cigna Commercial |
$5,005.80
|
| Rate for Payer: First Health Commercial |
$5,729.53
|
| Rate for Payer: Humana Commercial |
$5,126.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,945.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,307.35
|
| Rate for Payer: Ohio Health Group HMO |
$4,523.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,824.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,247.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,161.45
|
| Rate for Payer: PHCS Commercial |
$5,789.84
|
| Rate for Payer: United Healthcare All Payer |
$5,307.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
OP
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,435.18 |
| Max. Negotiated Rate |
$6,797.84 |
| Rate for Payer: Aetna Commercial |
$5,452.43
|
| Rate for Payer: Anthem Medicaid |
$2,435.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.24
|
| 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 |
$3,540.54
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$5,877.30
|
| Rate for Payer: First Health Commercial |
$6,727.03
|
| Rate for Payer: Humana Commercial |
$6,018.92
|
| Rate for Payer: Humana KY Medicaid |
$2,435.18
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,459.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,664.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,885.95
|
| Rate for Payer: PHCS Commercial |
$6,797.84
|
| Rate for Payer: United Healthcare All Payer |
$6,231.35
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
761P0072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.13 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$449.06
|
| Rate for Payer: Ambetter Exchange |
$313.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.13
|
| Rate for Payer: Anthem Medicaid |
$173.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$375.91
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$413.66
|
| Rate for Payer: Healthspan PPO |
$516.54
|
| Rate for Payer: Humana Medicaid |
$173.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.88
|
| Rate for Payer: Molina Healthcare Passport |
$173.41
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.24
|
| Rate for Payer: UHCCP Medicaid |
$179.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.26
|
|
|
EXC HIDRADENITIS INGU COMP RPR
|
Facility
|
IP
|
$7,081.08
|
|
|
Service Code
|
HCPCS 11463
|
| Hospital Charge Code |
76100072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,124.32 |
| Max. Negotiated Rate |
$6,797.84 |
| Rate for Payer: Aetna Commercial |
$5,452.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.24
|
| Rate for Payer: Cash Price |
$3,540.54
|
| Rate for Payer: Cigna Commercial |
$5,877.30
|
| Rate for Payer: First Health Commercial |
$6,727.03
|
| Rate for Payer: Humana Commercial |
$6,018.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,664.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,885.95
|
| Rate for Payer: PHCS Commercial |
$6,797.84
|
| Rate for Payer: United Healthcare All Payer |
$6,231.35
|
|
|
EXC HIP PELVIS LES SC 3 CM/>
|
Facility
|
OP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
76100766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,460.60 |
| Max. Negotiated Rate |
$6,868.80 |
| Rate for Payer: Aetna Commercial |
$5,509.35
|
| Rate for Payer: Anthem Medicaid |
$2,460.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,580.90
|
| 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 |
$3,577.50
|
| Rate for Payer: Cash Price |
$3,577.50
|
| Rate for Payer: Cigna Commercial |
$5,938.65
|
| Rate for Payer: First Health Commercial |
$6,797.25
|
| Rate for Payer: Humana Commercial |
$6,081.75
|
| Rate for Payer: Humana KY Medicaid |
$2,460.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,485.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,867.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,509.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,296.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,366.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,936.95
|
| Rate for Payer: PHCS Commercial |
$6,868.80
|
| Rate for Payer: United Healthcare All Payer |
$6,296.40
|
|
|
EXC HIP PELVIS LES SC 3 CM/>
|
Professional
|
Both
|
$7,155.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
76100766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$4,293.00 |
| Rate for Payer: Aetna Commercial |
$723.55
|
| Rate for Payer: Ambetter Exchange |
$448.84
|
| Rate for Payer: Anthem Medicaid |
$339.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.61
|
| Rate for Payer: Cash Price |
$3,577.50
|
| Rate for Payer: Cash Price |
$3,577.50
|
| Rate for Payer: Cigna Commercial |
$823.10
|
| Rate for Payer: Healthspan PPO |
$515.62
|
| Rate for Payer: Humana Medicaid |
$339.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.62
|
| Rate for Payer: Molina Healthcare Passport |
$339.82
|
| Rate for Payer: Multiplan PHCS |
$4,293.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.49
|
| Rate for Payer: UHCCP Medicaid |
$2,504.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.84
|
|
|
EXC HIP PELVIS LES SC 3 CM/>
|
Facility
|
IP
|
$7,155.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
76100766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,146.50 |
| Max. Negotiated Rate |
$6,868.80 |
| Rate for Payer: Aetna Commercial |
$5,509.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,580.90
|
| Rate for Payer: Cash Price |
$3,577.50
|
| Rate for Payer: Cigna Commercial |
$5,938.65
|
| Rate for Payer: First Health Commercial |
$6,797.25
|
| Rate for Payer: Humana Commercial |
$6,081.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,867.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,146.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,296.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,366.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,224.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,936.95
|
| Rate for Payer: PHCS Commercial |
$6,868.80
|
| Rate for Payer: United Healthcare All Payer |
$6,296.40
|
|
|
EXC HIP PELVIS LES SC 3 CM/(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
761P0766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.82 |
| Max. Negotiated Rate |
$823.10 |
| Rate for Payer: Aetna Commercial |
$723.55
|
| Rate for Payer: Ambetter Exchange |
$448.84
|
| Rate for Payer: Anthem Medicaid |
$339.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.61
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$823.10
|
| Rate for Payer: Healthspan PPO |
$515.62
|
| Rate for Payer: Humana Medicaid |
$339.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.62
|
| Rate for Payer: Molina Healthcare Passport |
$339.82
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.49
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.84
|
|
|
EXC HIP PELVIS LES SC 3 CM/(T
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
761T0766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,801.50 |
| Max. Negotiated Rate |
$5,764.80 |
| Rate for Payer: Aetna Commercial |
$4,623.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,683.90
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$4,984.15
|
| Rate for Payer: First Health Commercial |
$5,704.75
|
| Rate for Payer: Humana Commercial |
$5,104.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,924.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,431.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,801.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,284.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,224.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.45
|
| Rate for Payer: PHCS Commercial |
$5,764.80
|
| Rate for Payer: United Healthcare All Payer |
$5,284.40
|
|
|
EXC HIP PELVIS LES SC 3 CM/(T
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
HCPCS 27043
|
| Hospital Charge Code |
761T0766
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,065.12 |
| Max. Negotiated Rate |
$5,764.80 |
| Rate for Payer: Aetna Commercial |
$4,623.85
|
| Rate for Payer: Anthem Medicaid |
$2,065.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,683.90
|
| 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 |
$3,002.50
|
| Rate for Payer: Cash Price |
$3,002.50
|
| Rate for Payer: Cigna Commercial |
$4,984.15
|
| Rate for Payer: First Health Commercial |
$5,704.75
|
| Rate for Payer: Humana Commercial |
$5,104.25
|
| Rate for Payer: Humana KY Medicaid |
$2,065.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,086.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,924.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,431.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,106.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,284.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,503.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,224.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,143.45
|
| Rate for Payer: PHCS Commercial |
$5,764.80
|
| Rate for Payer: United Healthcare All Payer |
$5,284.40
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27045
|
| Hospital Charge Code |
76100767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,308.51 |
| Rate for Payer: Aetna Commercial |
$1,150.33
|
| Rate for Payer: Ambetter Exchange |
$700.04
|
| Rate for Payer: Anthem Medicaid |
$540.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$840.05
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,308.51
|
| Rate for Payer: Healthspan PPO |
$820.77
|
| Rate for Payer: Humana Medicaid |
$540.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$947.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$551.28
|
| Rate for Payer: Molina Healthcare Passport |
$540.47
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.05
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.04
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27045
|
| Hospital Charge Code |
76100767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/>
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27045
|
| Hospital Charge Code |
76100767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| 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 |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXC HIP/PELV TUM DEEP 5 CM/(P
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27045
|
| Hospital Charge Code |
761P0767
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,308.51 |
| Rate for Payer: Aetna Commercial |
$1,150.33
|
| Rate for Payer: Ambetter Exchange |
$700.04
|
| Rate for Payer: Anthem Medicaid |
$540.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$840.05
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,308.51
|
| Rate for Payer: Healthspan PPO |
$820.77
|
| Rate for Payer: Humana Medicaid |
$540.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$947.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$551.28
|
| Rate for Payer: Molina Healthcare Passport |
$540.47
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.05
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$545.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.04
|
|
