|
EXCH PREVPLCABS/CYST DRAINCATH
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
76102001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.00 |
| Max. Negotiated Rate |
$3,004.80 |
| Rate for Payer: Aetna Commercial |
$2,410.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.40
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,597.90
|
| Rate for Payer: First Health Commercial |
$2,973.50
|
| Rate for Payer: Humana Commercial |
$2,660.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.70
|
| Rate for Payer: PHCS Commercial |
$3,004.80
|
| Rate for Payer: United Healthcare All Payer |
$2,754.40
|
|
|
EXCH PREVPLCABS/CYST DRAINCATH
|
Facility
|
IP
|
$2,855.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
761T2001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$856.50 |
| Max. Negotiated Rate |
$2,740.80 |
| Rate for Payer: Aetna Commercial |
$2,198.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,226.90
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cigna Commercial |
$2,369.65
|
| Rate for Payer: First Health Commercial |
$2,712.25
|
| Rate for Payer: Humana Commercial |
$2,426.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$856.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,512.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,483.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.95
|
| Rate for Payer: PHCS Commercial |
$2,740.80
|
| Rate for Payer: United Healthcare All Payer |
$2,512.40
|
|
|
EXCH PREVPLCABS/CYST DRAINCATH
|
Professional
|
Both
|
$3,130.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
76102001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$1,878.00 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: Ambetter Exchange |
$65.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.11
|
| Rate for Payer: Anthem Medicaid |
$73.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$110.58
|
| Rate for Payer: Healthspan PPO |
$679.05
|
| Rate for Payer: Humana Medicaid |
$73.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.09
|
| Rate for Payer: Molina Healthcare Passport |
$73.62
|
| Rate for Payer: Multiplan PHCS |
$1,878.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.58
|
| Rate for Payer: UHCCP Medicaid |
$70.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.83
|
|
|
EXCH PREVPLCABS/CYST DRAINCATH
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
76102001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,076.41 |
| Max. Negotiated Rate |
$3,004.80 |
| Rate for Payer: Aetna Commercial |
$2,410.10
|
| Rate for Payer: Anthem Medicaid |
$1,076.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cash Price |
$1,565.00
|
| Rate for Payer: Cigna Commercial |
$2,597.90
|
| Rate for Payer: First Health Commercial |
$2,973.50
|
| Rate for Payer: Humana Commercial |
$2,660.50
|
| Rate for Payer: Humana KY Medicaid |
$1,076.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.70
|
| Rate for Payer: PHCS Commercial |
$3,004.80
|
| Rate for Payer: United Healthcare All Payer |
$2,754.40
|
|
|
EXCH PREVPLCABS/CYST DRAINCATH
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
761P2001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.83 |
| Max. Negotiated Rate |
$679.05 |
| Rate for Payer: Aetna Commercial |
$122.81
|
| Rate for Payer: Ambetter Exchange |
$65.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.11
|
| Rate for Payer: Anthem Medicaid |
$73.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$110.58
|
| Rate for Payer: Healthspan PPO |
$679.05
|
| Rate for Payer: Humana Medicaid |
$73.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.09
|
| Rate for Payer: Molina Healthcare Passport |
$73.62
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.58
|
| Rate for Payer: UHCCP Medicaid |
$70.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.83
|
|
|
EXCH PREVPLCABS/CYST DRAINCATH
|
Facility
|
OP
|
$2,855.00
|
|
|
Service Code
|
HCPCS 49423
|
| Hospital Charge Code |
761T2001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$981.83 |
| Max. Negotiated Rate |
$2,740.80 |
| Rate for Payer: Aetna Commercial |
$2,198.35
|
| Rate for Payer: Anthem Medicaid |
$981.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,752.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,226.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,453.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,366.25
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cigna Commercial |
$2,369.65
|
| Rate for Payer: First Health Commercial |
$2,712.25
|
| Rate for Payer: Humana Commercial |
$2,426.75
|
| Rate for Payer: Humana KY Medicaid |
$981.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,752.78
|
| Rate for Payer: Kentucky WC Medicaid |
$991.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,341.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,103.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,001.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,512.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,141.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,483.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,969.95
|
| Rate for Payer: PHCS Commercial |
$2,740.80
|
| Rate for Payer: United Healthcare All Payer |
$2,512.40
|
|
|
EXC HYRO SPERMATIC CORD
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55500
|
| Hospital Charge Code |
76102150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Ambetter Exchange |
$371.20
|
| Rate for Payer: Anthem Medicaid |
$282.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$371.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$371.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.44
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$542.29
|
| Rate for Payer: Healthspan PPO |
$588.33
|
| Rate for Payer: Humana Medicaid |
$282.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$371.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.61
|
| Rate for Payer: Molina Healthcare Passport |
$282.95
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$482.56
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$371.20
|
|
|
EXC HYRO SPERMATIC CORD
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55500
|
| Hospital Charge Code |
76102150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXC HYRO SPERMATIC CORD
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55500
|
| Hospital Charge Code |
76102150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
EXC HYRO SPERMATIC CORD(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 55500
|
| Hospital Charge Code |
761P2150
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Ambetter Exchange |
$371.20
|
| Rate for Payer: Anthem Medicaid |
$282.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$371.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$371.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.44
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$542.29
|
| Rate for Payer: Healthspan PPO |
$588.33
|
| Rate for Payer: Humana Medicaid |
$282.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$371.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$371.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.61
|
| Rate for Payer: Molina Healthcare Passport |
$282.95
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$482.56
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$371.20
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
76100410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,289.62 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$2,887.50
|
| Rate for Payer: Anthem Medicaid |
$1,289.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,925.00
|
| 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 |
$1,875.00
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$3,112.50
|
| Rate for Payer: First Health Commercial |
$3,562.50
|
| Rate for Payer: Humana Commercial |
$3,187.50
|
| Rate for Payer: Humana KY Medicaid |
$1,289.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,302.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,075.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,767.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,315.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,300.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.50
|
| Rate for Payer: PHCS Commercial |
$3,600.00
|
| Rate for Payer: United Healthcare All Payer |
$3,300.00
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
76100410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$2,887.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,925.00
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$3,112.50
|
| Rate for Payer: First Health Commercial |
$3,562.50
|
| Rate for Payer: Humana Commercial |
$3,187.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,075.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,767.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,300.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,812.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,262.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.50
|
| Rate for Payer: PHCS Commercial |
$3,600.00
|
| Rate for Payer: United Healthcare All Payer |
$3,300.00
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
761T0410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,177.86 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| 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 |
$1,712.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Professional
|
Both
|
$3,750.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
76100410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$225.32
|
| Rate for Payer: Ambetter Exchange |
$145.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.44
|
| Rate for Payer: Anthem Medicaid |
$82.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.09
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cash Price |
$1,875.00
|
| Rate for Payer: Cigna Commercial |
$356.32
|
| Rate for Payer: Healthspan PPO |
$315.59
|
| Rate for Payer: Humana Medicaid |
$82.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.50
|
| Rate for Payer: Molina Healthcare Passport |
$82.84
|
| Rate for Payer: Multiplan PHCS |
$2,250.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.68
|
| Rate for Payer: UHCCP Medicaid |
$91.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.91
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
761T0410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
EXCI BIOPSY SFT TIS BACK FLANK
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 21920
|
| Hospital Charge Code |
761P0410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$356.32 |
| Rate for Payer: Aetna Commercial |
$225.32
|
| Rate for Payer: Ambetter Exchange |
$145.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.44
|
| Rate for Payer: Anthem Medicaid |
$82.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$145.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.09
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$356.32
|
| Rate for Payer: Healthspan PPO |
$315.59
|
| Rate for Payer: Humana Medicaid |
$82.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$200.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.50
|
| Rate for Payer: Molina Healthcare Passport |
$82.84
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.68
|
| Rate for Payer: UHCCP Medicaid |
$91.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$145.91
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Aetna Commercial |
$740.76
|
| Rate for Payer: Ambetter Exchange |
$505.02
|
| Rate for Payer: Anthem Medicaid |
$247.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.02
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$793.25
|
| Rate for Payer: Healthspan PPO |
$670.97
|
| Rate for Payer: Humana Medicaid |
$247.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.29
|
| Rate for Payer: Molina Healthcare Passport |
$247.34
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.53
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.02
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
76100822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EXCI LES MNSCS/CPSL (GANGLION)
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27347
|
| Hospital Charge Code |
761P0822
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$793.25 |
| Rate for Payer: Aetna Commercial |
$740.76
|
| Rate for Payer: Ambetter Exchange |
$505.02
|
| Rate for Payer: Anthem Medicaid |
$247.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$505.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$606.02
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$793.25
|
| Rate for Payer: Healthspan PPO |
$670.97
|
| Rate for Payer: Humana Medicaid |
$247.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$505.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$252.29
|
| Rate for Payer: Molina Healthcare Passport |
$247.34
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$656.53
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$505.02
|
|
|
EXC INTRACARDIAC TUMOR
|
Facility
|
OP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem Medicaid |
$1,925.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Humana KY Medicaid |
$1,925.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,945.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,964.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
EXC INTRACARDIAC TUMOR
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
EXC INTRACARDIAC TUMOR
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
76101240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,562.79 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,649.93
|
| Rate for Payer: Ambetter Exchange |
$1,964.50
|
| Rate for Payer: Anthem Medicaid |
$1,562.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,964.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,964.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,357.40
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$2,486.81
|
| Rate for Payer: Healthspan PPO |
$2,605.40
|
| Rate for Payer: Humana Medicaid |
$1,562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,179.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,964.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,594.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,562.79
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,553.85
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,578.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,964.50
|
|
|
EXC INTRACARDIAC TUMOR(P
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 33120
|
| Hospital Charge Code |
761P1240
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,562.79 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,649.93
|
| Rate for Payer: Ambetter Exchange |
$1,964.50
|
| Rate for Payer: Anthem Medicaid |
$1,562.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,964.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,964.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,357.40
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$2,486.81
|
| Rate for Payer: Healthspan PPO |
$2,605.40
|
| Rate for Payer: Humana Medicaid |
$1,562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,179.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,964.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,594.05
|
| Rate for Payer: Molina Healthcare Passport |
$1,562.79
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,553.85
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,578.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,964.50
|
|
|
EXC I PRESSURE ULCER
|
Facility
|
IP
|
$9,203.70
|
|
|
Service Code
|
HCPCS 15941
|
| Hospital Charge Code |
76100237
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,761.11 |
| Max. Negotiated Rate |
$8,835.55 |
| Rate for Payer: Aetna Commercial |
$7,086.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,178.89
|
| Rate for Payer: Cash Price |
$4,601.85
|
| Rate for Payer: Cigna Commercial |
$7,639.07
|
| Rate for Payer: First Health Commercial |
$8,743.51
|
| Rate for Payer: Humana Commercial |
$7,823.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,362.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,007.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,350.55
|
| Rate for Payer: PHCS Commercial |
$8,835.55
|
| Rate for Payer: United Healthcare All Payer |
$8,099.26
|
|
