|
OPEN BIOPSY OF LUNG PLEURA
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
OPEN BIOPSY OF LUNG PLEURA
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
OPEN BIOPSY OF LUNG PLEURA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
76101173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.63 |
| Max. Negotiated Rate |
$1,431.07 |
| Rate for Payer: Ambetter Exchange |
$713.40
|
| Rate for Payer: Anthem Medicaid |
$616.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$713.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$713.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$856.08
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,431.07
|
| Rate for Payer: Healthspan PPO |
$765.54
|
| Rate for Payer: Humana Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$713.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$713.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.96
|
| Rate for Payer: Molina Healthcare Passport |
$616.63
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.42
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$713.40
|
|
|
OPEN BIOPSY OF LUNG PLEURA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 32098
|
| Hospital Charge Code |
761P1173
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.63 |
| Max. Negotiated Rate |
$1,431.07 |
| Rate for Payer: Ambetter Exchange |
$713.40
|
| Rate for Payer: Anthem Medicaid |
$616.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$713.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$713.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$856.08
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,431.07
|
| Rate for Payer: Healthspan PPO |
$765.54
|
| Rate for Payer: Humana Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$713.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$713.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.96
|
| Rate for Payer: Molina Healthcare Passport |
$616.63
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.42
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$713.40
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Facility
|
OP
|
$6,334.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,178.26 |
| Max. Negotiated Rate |
$6,080.64 |
| Rate for Payer: Aetna Commercial |
$4,877.18
|
| Rate for Payer: Anthem Medicaid |
$2,178.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,940.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,167.00
|
| Rate for Payer: Cash Price |
$3,167.00
|
| Rate for Payer: Cigna Commercial |
$5,257.22
|
| Rate for Payer: First Health Commercial |
$6,017.30
|
| Rate for Payer: Humana Commercial |
$5,383.90
|
| Rate for Payer: Humana KY Medicaid |
$2,178.26
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,200.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,193.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,674.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,221.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,573.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,750.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,510.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,370.46
|
| Rate for Payer: PHCS Commercial |
$6,080.64
|
| Rate for Payer: United Healthcare All Payer |
$5,573.92
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Professional
|
Both
|
$6,334.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.70 |
| Max. Negotiated Rate |
$3,800.40 |
| Rate for Payer: Ambetter Exchange |
$426.18
|
| Rate for Payer: Anthem Medicaid |
$350.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$426.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$511.42
|
| Rate for Payer: Cash Price |
$3,167.00
|
| Rate for Payer: Cash Price |
$3,167.00
|
| Rate for Payer: Cigna Commercial |
$721.01
|
| Rate for Payer: Humana Medicaid |
$350.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$562.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$426.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.71
|
| Rate for Payer: Molina Healthcare Passport |
$350.70
|
| Rate for Payer: Multiplan PHCS |
$3,800.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$554.03
|
| Rate for Payer: UHCCP Medicaid |
$2,216.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$426.18
|
|
|
OPEN BX/EXC INGUINOFEM NODES
|
Facility
|
IP
|
$6,334.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
76101599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,900.20 |
| Max. Negotiated Rate |
$6,080.64 |
| Rate for Payer: Aetna Commercial |
$4,877.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,940.52
|
| Rate for Payer: Cash Price |
$3,167.00
|
| Rate for Payer: Cigna Commercial |
$5,257.22
|
| Rate for Payer: First Health Commercial |
$6,017.30
|
| Rate for Payer: Humana Commercial |
$5,383.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,193.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,674.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,900.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,573.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,750.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,510.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,370.46
|
| Rate for Payer: PHCS Commercial |
$6,080.64
|
| Rate for Payer: United Healthcare All Payer |
$5,573.92
|
|
|
OPEN BX/EXC INGUINOFEM NODES(P
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761P1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$721.01 |
| Rate for Payer: Ambetter Exchange |
$426.18
|
| Rate for Payer: Anthem Medicaid |
$350.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$426.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$426.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$511.42
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$721.01
|
| Rate for Payer: Humana Medicaid |
$350.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$562.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$426.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.71
|
| Rate for Payer: Molina Healthcare Passport |
$350.70
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$554.03
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$354.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$426.18
|
|
|
OPEN BX/EXC INGUINOFEM NODES(T
|
Facility
|
IP
|
$5,694.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761T1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,708.20 |
| Max. Negotiated Rate |
$5,466.24 |
| Rate for Payer: Aetna Commercial |
$4,384.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.32
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cigna Commercial |
$4,726.02
|
| Rate for Payer: First Health Commercial |
$5,409.30
|
| Rate for Payer: Humana Commercial |
$4,839.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,669.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.86
|
| Rate for Payer: PHCS Commercial |
$5,466.24
|
| Rate for Payer: United Healthcare All Payer |
$5,010.72
|
|
|
OPEN BX/EXC INGUINOFEM NODES(T
|
Facility
|
OP
|
$5,694.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
761T1599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,958.17 |
| Max. Negotiated Rate |
$5,466.24 |
| Rate for Payer: Aetna Commercial |
$4,384.38
|
| Rate for Payer: Anthem Medicaid |
$1,958.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,441.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cash Price |
$2,847.00
|
| Rate for Payer: Cigna Commercial |
$4,726.02
|
| Rate for Payer: First Health Commercial |
$5,409.30
|
| Rate for Payer: Humana Commercial |
$4,839.90
|
| Rate for Payer: Humana KY Medicaid |
$1,958.17
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,978.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,669.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.86
|
| Rate for Payer: PHCS Commercial |
$5,466.24
|
| Rate for Payer: United Healthcare All Payer |
$5,010.72
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OPEN CHOLECYST EXPLOR DUCT
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
76101969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.62 |
| Max. Negotiated Rate |
$1,807.44 |
| Rate for Payer: Aetna Commercial |
$1,807.44
|
| Rate for Payer: Ambetter Exchange |
$1,196.47
|
| Rate for Payer: Anthem Medicaid |
$706.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,196.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,196.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,435.76
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,681.50
|
| Rate for Payer: Healthspan PPO |
$1,524.24
|
| Rate for Payer: Humana Medicaid |
$706.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,599.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,196.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.75
|
| Rate for Payer: Molina Healthcare Passport |
$706.62
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,555.41
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,196.47
|
|
|
OPEN CHOLECYST EXPLOR DUCT(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 47610
|
| Hospital Charge Code |
761P1969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.62 |
| Max. Negotiated Rate |
$1,807.44 |
| Rate for Payer: Aetna Commercial |
$1,807.44
|
| Rate for Payer: Ambetter Exchange |
$1,196.47
|
| Rate for Payer: Anthem Medicaid |
$706.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,196.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,196.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,435.76
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,681.50
|
| Rate for Payer: Healthspan PPO |
$1,524.24
|
| Rate for Payer: Humana Medicaid |
$706.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,599.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,196.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.75
|
| Rate for Payer: Molina Healthcare Passport |
$706.62
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,555.41
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,196.47
|
|
|
OPEN DRAINAGE LIVER LESION
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
76101947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.26 |
| Max. Negotiated Rate |
$1,698.39 |
| Rate for Payer: Aetna Commercial |
$1,698.39
|
| Rate for Payer: Ambetter Exchange |
$1,154.57
|
| Rate for Payer: Anthem Medicaid |
$465.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,154.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,154.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,385.48
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,585.09
|
| Rate for Payer: Healthspan PPO |
$1,432.28
|
| Rate for Payer: Humana Medicaid |
$465.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,523.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,154.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.57
|
| Rate for Payer: Molina Healthcare Passport |
$465.26
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,500.94
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,154.57
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
76101947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Humana KY Medicaid |
$894.14
|
| Rate for Payer: Kentucky WC Medicaid |
$903.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
OPEN DRAINAGE LIVER LESION
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
76101947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$2,158.00
|
| Rate for Payer: First Health Commercial |
$2,470.00
|
| Rate for Payer: Humana Commercial |
$2,210.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
|
OPEN DRAINAGE LIVER LESION(P
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 47010
|
| Hospital Charge Code |
761P1947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.26 |
| Max. Negotiated Rate |
$1,698.39 |
| Rate for Payer: Aetna Commercial |
$1,698.39
|
| Rate for Payer: Ambetter Exchange |
$1,154.57
|
| Rate for Payer: Anthem Medicaid |
$465.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,154.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,154.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,385.48
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cigna Commercial |
$1,585.09
|
| Rate for Payer: Healthspan PPO |
$1,432.28
|
| Rate for Payer: Humana Medicaid |
$465.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,523.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,154.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.57
|
| Rate for Payer: Molina Healthcare Passport |
$465.26
|
| Rate for Payer: Multiplan PHCS |
$1,560.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,500.94
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,154.57
|
|
|
OPEN EXCISION PATELLAR OSSICLE
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$732.90 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$732.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.67
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
OPEN EXCISION PATELLAR OSSICLE
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,345.28 |
| Rate for Payer: Aetna Commercial |
$1,881.11
|
| Rate for Payer: Anthem Medicaid |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,905.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$2,027.69
|
| Rate for Payer: First Health Commercial |
$2,320.85
|
| Rate for Payer: Humana Commercial |
$2,076.55
|
| Rate for Payer: Humana KY Medicaid |
$840.15
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,003.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,802.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$857.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,149.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,832.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,125.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.67
|
| Rate for Payer: PHCS Commercial |
$2,345.28
|
| Rate for Payer: United Healthcare All Payer |
$2,149.84
|
|
|
OPEN EXCISION PATELLAR OSSICLE
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76102932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,710.10 |
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,465.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,710.10
|
| Rate for Payer: UHCCP Medicaid |
$855.05
|
|
|
OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT)
|
Facility
|
OP
|
$8,489.59
|
|
|
Service Code
|
CPT 64581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,063.99 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
|
|
OPEN OSTEOCHONDRAL AUTOGRAFT, TALUS (INCLUDES OBTAINING GRAFT[S])
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 28446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
OPEN/PERQ PLACE STENT 1ST
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
76101560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
OPEN/PERQ PLACE STENT 1ST
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS 37236
|
| Hospital Charge Code |
76101560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,848.46 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
