|
EXPLORE WOUND CHEST
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
EXPLORE WOUND CHEST
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
EXPLORE WOUND CHEST
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.84 |
| Max. Negotiated Rate |
$494.88 |
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Ambetter Exchange |
$199.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.84
|
| Rate for Payer: Anthem Medicaid |
$139.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$199.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$199.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$238.87
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$320.85
|
| Rate for Payer: Healthspan PPO |
$494.88
|
| Rate for Payer: Humana Medicaid |
$139.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$199.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.91
|
| Rate for Payer: Molina Healthcare Passport |
$139.13
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$258.78
|
| Rate for Payer: UHCCP Medicaid |
$114.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$199.06
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,241.10 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$3,433.71
|
| Rate for Payer: First Health Commercial |
$3,930.15
|
| Rate for Payer: Humana Commercial |
$3,516.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.53
|
| Rate for Payer: PHCS Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare All Payer |
$3,640.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$2,937.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761T0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$881.10 |
| Max. Negotiated Rate |
$2,819.52 |
| Rate for Payer: Aetna Commercial |
$2,261.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.86
|
| Rate for Payer: Cash Price |
$1,468.50
|
| Rate for Payer: Cigna Commercial |
$2,437.71
|
| Rate for Payer: First Health Commercial |
$2,790.15
|
| Rate for Payer: Humana Commercial |
$2,496.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,584.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.53
|
| Rate for Payer: PHCS Commercial |
$2,819.52
|
| Rate for Payer: United Healthcare All Payer |
$2,584.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$2,937.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$881.10 |
| Max. Negotiated Rate |
$2,819.52 |
| Rate for Payer: Aetna Commercial |
$2,261.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.86
|
| Rate for Payer: Cash Price |
$1,468.50
|
| Rate for Payer: Cigna Commercial |
$2,437.71
|
| Rate for Payer: First Health Commercial |
$2,790.15
|
| Rate for Payer: Humana Commercial |
$2,496.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,584.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.53
|
| Rate for Payer: PHCS Commercial |
$2,819.52
|
| Rate for Payer: United Healthcare All Payer |
$2,584.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$2,937.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761T0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,010.03 |
| Max. Negotiated Rate |
$2,819.52 |
| Rate for Payer: Aetna Commercial |
$2,261.49
|
| Rate for Payer: Anthem Medicaid |
$1,010.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.86
|
| 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 |
$1,468.50
|
| Rate for Payer: Cash Price |
$1,468.50
|
| Rate for Payer: Cigna Commercial |
$2,437.71
|
| Rate for Payer: First Health Commercial |
$2,790.15
|
| Rate for Payer: Humana Commercial |
$2,496.45
|
| Rate for Payer: Humana KY Medicaid |
$1,010.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,584.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.53
|
| Rate for Payer: PHCS Commercial |
$2,819.52
|
| Rate for Payer: United Healthcare All Payer |
$2,584.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Professional
|
Both
|
$4,137.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$2,482.20 |
| Rate for Payer: Aetna Commercial |
$521.02
|
| Rate for Payer: Ambetter Exchange |
$326.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$229.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$326.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$326.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.64
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$568.43
|
| Rate for Payer: Healthspan PPO |
$711.91
|
| Rate for Payer: Humana Medicaid |
$229.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$326.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.89
|
| Rate for Payer: Molina Healthcare Passport |
$229.30
|
| Rate for Payer: Multiplan PHCS |
$2,482.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.28
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$326.37
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$2,937.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,010.03 |
| Max. Negotiated Rate |
$2,819.52 |
| Rate for Payer: Aetna Commercial |
$2,261.49
|
| Rate for Payer: Anthem Medicaid |
$1,010.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,290.86
|
| 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 |
$1,468.50
|
| Rate for Payer: Cash Price |
$1,468.50
|
| Rate for Payer: Cigna Commercial |
$2,437.71
|
| Rate for Payer: First Health Commercial |
$2,790.15
|
| Rate for Payer: Humana Commercial |
$2,496.45
|
| Rate for Payer: Humana KY Medicaid |
$1,010.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,584.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,202.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,349.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.53
|
| Rate for Payer: PHCS Commercial |
$2,819.52
|
| Rate for Payer: United Healthcare All Payer |
$2,584.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$4,137.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,422.71 |
| Max. Negotiated Rate |
$3,971.52 |
| Rate for Payer: Aetna Commercial |
$3,185.49
|
| Rate for Payer: Anthem Medicaid |
$1,422.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,226.86
|
| 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 |
$2,068.50
|
| Rate for Payer: Cash Price |
$2,068.50
|
| Rate for Payer: Cigna Commercial |
$3,433.71
|
| Rate for Payer: First Health Commercial |
$3,930.15
|
| Rate for Payer: Humana Commercial |
$3,516.45
|
| Rate for Payer: Humana KY Medicaid |
$1,422.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,437.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,392.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,053.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,451.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,640.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,102.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,309.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,599.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.53
|
| Rate for Payer: PHCS Commercial |
$3,971.52
|
| Rate for Payer: United Healthcare All Payer |
$3,640.56
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761P0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$521.02
|
| Rate for Payer: Ambetter Exchange |
$326.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$229.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$326.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$326.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.64
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$568.43
|
| Rate for Payer: Healthspan PPO |
$711.91
|
| Rate for Payer: Humana Medicaid |
$229.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$326.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.89
|
| Rate for Payer: Molina Healthcare Passport |
$229.30
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.28
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$326.37
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$1,591.66 |
| Rate for Payer: Aetna Commercial |
$1,591.66
|
| Rate for Payer: Ambetter Exchange |
$1,112.40
|
| Rate for Payer: Anthem Medicaid |
$581.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,112.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,112.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,334.88
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,452.12
|
| Rate for Payer: Healthspan PPO |
$1,342.28
|
| Rate for Payer: Humana Medicaid |
$581.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,112.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.62
|
| Rate for Payer: Molina Healthcare Passport |
$581.98
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,446.12
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,112.40
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXPLOR REPAIR RECTAL INJURY(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
761P1906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$1,591.66 |
| Rate for Payer: Aetna Commercial |
$1,591.66
|
| Rate for Payer: Ambetter Exchange |
$1,112.40
|
| Rate for Payer: Anthem Medicaid |
$581.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,112.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,112.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,334.88
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,452.12
|
| Rate for Payer: Healthspan PPO |
$1,342.28
|
| Rate for Payer: Humana Medicaid |
$581.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,112.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.62
|
| Rate for Payer: Molina Healthcare Passport |
$581.98
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,446.12
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,112.40
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.60 |
| Max. Negotiated Rate |
$1,371.50 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Ambetter Exchange |
$882.04
|
| Rate for Payer: Anthem Medicaid |
$546.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$882.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$882.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.45
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,264.83
|
| Rate for Payer: Healthspan PPO |
$1,156.61
|
| Rate for Payer: Humana Medicaid |
$546.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$882.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.53
|
| Rate for Payer: Molina Healthcare Passport |
$546.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,146.65
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$882.04
|
|
|
EXPLOR - RETROPERITONEAL BX
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
76101976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLOR - RETROPERITONEAL BX(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49010
|
| Hospital Charge Code |
761P1976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.60 |
| Max. Negotiated Rate |
$1,371.50 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Ambetter Exchange |
$882.04
|
| Rate for Payer: Anthem Medicaid |
$546.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$882.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$882.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.45
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,264.83
|
| Rate for Payer: Healthspan PPO |
$1,156.61
|
| Rate for Payer: Humana Medicaid |
$546.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,214.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$882.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.53
|
| Rate for Payer: Molina Healthcare Passport |
$546.60
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,146.65
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$552.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$882.04
|
|
|
EXPLOR SCROTAL
|
Facility
|
OP
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.12 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem Medicaid |
$199.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$451.62
|
| 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 |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Humana KY Medicaid |
$199.12
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$201.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$203.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$463.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.51
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
EXPLOR SCROTAL
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$618.28 |
| Rate for Payer: Aetna Commercial |
$618.28
|
| Rate for Payer: Ambetter Exchange |
$369.47
|
| Rate for Payer: Anthem Medicaid |
$257.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$369.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$443.36
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$546.88
|
| Rate for Payer: Healthspan PPO |
$598.66
|
| Rate for Payer: Humana Medicaid |
$257.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$369.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.41
|
| Rate for Payer: Molina Healthcare Passport |
$257.26
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$480.31
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$369.47
|
|
|
EXPLOR SCROTAL
|
Facility
|
IP
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
76102146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.70 |
| Max. Negotiated Rate |
$555.84 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$451.62
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$480.57
|
| Rate for Payer: First Health Commercial |
$550.05
|
| Rate for Payer: Humana Commercial |
$492.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$474.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$427.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$509.52
|
| Rate for Payer: Ohio Health Group HMO |
$434.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$463.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.51
|
| Rate for Payer: PHCS Commercial |
$555.84
|
| Rate for Payer: United Healthcare All Payer |
$509.52
|
|
|
EXPLOR SCROTAL(P
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 55110
|
| Hospital Charge Code |
761P2146
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.65 |
| Max. Negotiated Rate |
$618.28 |
| Rate for Payer: Aetna Commercial |
$618.28
|
| Rate for Payer: Ambetter Exchange |
$369.47
|
| Rate for Payer: Anthem Medicaid |
$257.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$369.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$369.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$443.36
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cash Price |
$289.50
|
| Rate for Payer: Cigna Commercial |
$546.88
|
| Rate for Payer: Healthspan PPO |
$598.66
|
| Rate for Payer: Humana Medicaid |
$257.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$369.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.41
|
| Rate for Payer: Molina Healthcare Passport |
$257.26
|
| Rate for Payer: Multiplan PHCS |
$347.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$480.31
|
| Rate for Payer: UHCCP Medicaid |
$202.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$369.47
|
|
|
EXPL POSTSURG ABDOMEN
|
Facility
|
OP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem Medicaid |
$707.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Humana KY Medicaid |
$707.75
|
| Rate for Payer: Kentucky WC Medicaid |
$714.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,790.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.02
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
|
EXPL POSTSURG ABDOMEN
|
Facility
|
IP
|
$2,058.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.40 |
| Max. Negotiated Rate |
$1,975.68 |
| Rate for Payer: Aetna Commercial |
$1,584.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,605.24
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,708.14
|
| Rate for Payer: First Health Commercial |
$1,955.10
|
| Rate for Payer: Humana Commercial |
$1,749.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,687.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,811.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,543.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,646.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,790.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,420.02
|
| Rate for Payer: PHCS Commercial |
$1,975.68
|
| Rate for Payer: United Healthcare All Payer |
$1,811.04
|
|
