|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$24,628.21
|
|
|
Service Code
|
MSDRG 336
|
| Min. Negotiated Rate |
$16,712.00 |
| Max. Negotiated Rate |
$24,628.21 |
| Rate for Payer: Anthem Medicaid |
$16,712.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,591.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,628.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,748.63
|
| Rate for Payer: Humana KY Medicaid |
$16,712.00
|
| Rate for Payer: Humana Medicare Advantage |
$17,591.58
|
| Rate for Payer: Kentucky WC Medicaid |
$16,879.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,109.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,046.24
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$41,821.09
|
|
|
Service Code
|
MSDRG 335
|
| Min. Negotiated Rate |
$28,378.60 |
| Max. Negotiated Rate |
$41,821.09 |
| Rate for Payer: Anthem Medicaid |
$28,378.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,872.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,821.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$40,327.48
|
| Rate for Payer: Humana KY Medicaid |
$28,378.60
|
| Rate for Payer: Humana Medicare Advantage |
$29,872.21
|
| Rate for Payer: Kentucky WC Medicaid |
$28,662.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,846.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,946.17
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,505.19
|
|
|
Service Code
|
MSDRG 337
|
| Min. Negotiated Rate |
$11,878.52 |
| Max. Negotiated Rate |
$17,505.19 |
| Rate for Payer: Anthem Medicaid |
$11,878.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,503.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,505.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,880.01
|
| Rate for Payer: Humana KY Medicaid |
$11,878.52
|
| Rate for Payer: Humana Medicare Advantage |
$12,503.71
|
| Rate for Payer: Kentucky WC Medicaid |
$11,997.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,004.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,116.09
|
|
|
PERITONEAL FLUID CELL CNT
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
PERITONEAL FLUID CELL CNT
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001537
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Professional
|
Both
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$1,641.00 |
| Rate for Payer: Aetna Commercial |
$357.80
|
| Rate for Payer: Anthem Medicaid |
$120.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,641.00
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$277.46
|
| Rate for Payer: Healthspan PPO |
$357.62
|
| Rate for Payer: Humana Medicaid |
$120.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.84
|
| Rate for Payer: Molina Healthcare Passport |
$120.43
|
| Rate for Payer: Multiplan PHCS |
$984.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.70
|
| Rate for Payer: UHCCP Medicaid |
$574.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.63
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$213.33 |
| Max. Negotiated Rate |
$1,575.36 |
| Rate for Payer: Aetna Commercial |
$1,263.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.98
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$1,362.03
|
| Rate for Payer: First Health Commercial |
$1,558.95
|
| Rate for Payer: Humana Commercial |
$1,394.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,345.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.71
|
| Rate for Payer: PHCS Commercial |
$1,575.36
|
| Rate for Payer: United Healthcare All Payer |
$1,444.08
|
|
|
PERITONEAL-VEN.SHUNT TEST
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
34000076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$213.33 |
| Max. Negotiated Rate |
$1,575.36 |
| Rate for Payer: Aetna Commercial |
$1,263.57
|
| Rate for Payer: Anthem Medicaid |
$564.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cash Price |
$820.50
|
| Rate for Payer: Cigna Commercial |
$1,362.03
|
| Rate for Payer: First Health Commercial |
$1,558.95
|
| Rate for Payer: Humana Commercial |
$1,394.85
|
| Rate for Payer: Humana KY Medicaid |
$564.34
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$570.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,345.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.71
|
| Rate for Payer: PHCS Commercial |
$1,575.36
|
| Rate for Payer: United Healthcare All Payer |
$1,444.08
|
|
|
PERITONEAL-VEN.SHUNT TEST(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340P0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$49.25 |
| Max. Negotiated Rate |
$357.80 |
| Rate for Payer: Aetna Commercial |
$357.80
|
| Rate for Payer: Anthem Medicaid |
$120.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$277.46
|
| Rate for Payer: Healthspan PPO |
$357.62
|
| Rate for Payer: Humana Medicaid |
$120.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.84
|
| Rate for Payer: Molina Healthcare Passport |
$120.43
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.63
|
|
|
PERITONEAL-VEN.SHUNT TEST(T
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340T0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$167.83 |
| Max. Negotiated Rate |
$1,239.36 |
| Rate for Payer: Aetna Commercial |
$994.07
|
| Rate for Payer: Anthem Medicaid |
$443.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cigna Commercial |
$1,071.53
|
| Rate for Payer: First Health Commercial |
$1,226.45
|
| Rate for Payer: Humana Commercial |
$1,097.35
|
| Rate for Payer: Humana KY Medicaid |
$443.97
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$448.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,058.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.08
|
| Rate for Payer: Ohio Health Group HMO |
$968.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.21
|
| Rate for Payer: PHCS Commercial |
$1,239.36
|
| Rate for Payer: United Healthcare All Payer |
$1,136.08
|
|
|
PERITONEAL-VEN.SHUNT TEST(T
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS 78291
|
| Hospital Charge Code |
340T0076
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$167.83 |
| Max. Negotiated Rate |
$1,239.36 |
| Rate for Payer: Aetna Commercial |
$994.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.98
|
| Rate for Payer: Cash Price |
$645.50
|
| Rate for Payer: Cigna Commercial |
$1,071.53
|
| Rate for Payer: First Health Commercial |
$1,226.45
|
| Rate for Payer: Humana Commercial |
$1,097.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,058.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,136.08
|
| Rate for Payer: Ohio Health Group HMO |
$968.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$400.21
|
| Rate for Payer: PHCS Commercial |
$1,239.36
|
| Rate for Payer: United Healthcare All Payer |
$1,136.08
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$26,643.85
|
|
|
Service Code
|
MSDRG 243
|
| Min. Negotiated Rate |
$18,079.75 |
| Max. Negotiated Rate |
$26,643.85 |
| Rate for Payer: Anthem Medicaid |
$18,079.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,031.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,643.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,692.28
|
| Rate for Payer: Humana KY Medicaid |
$18,079.75
|
| Rate for Payer: Humana Medicare Advantage |
$19,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$18,260.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,837.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,441.35
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$40,418.48
|
|
|
Service Code
|
MSDRG 242
|
| Min. Negotiated Rate |
$27,426.82 |
| Max. Negotiated Rate |
$40,418.48 |
| Rate for Payer: Anthem Medicaid |
$27,426.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,870.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40,418.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,974.96
|
| Rate for Payer: Humana KY Medicaid |
$27,426.82
|
| Rate for Payer: Humana Medicare Advantage |
$28,870.34
|
| Rate for Payer: Kentucky WC Medicaid |
$27,701.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,644.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,975.36
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$21,401.86
|
|
|
Service Code
|
MSDRG 244
|
| Min. Negotiated Rate |
$14,522.69 |
| Max. Negotiated Rate |
$21,401.86 |
| Rate for Payer: Anthem Medicaid |
$14,522.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,401.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,637.50
|
| Rate for Payer: Humana KY Medicaid |
$14,522.69
|
| Rate for Payer: Humana Medicare Advantage |
$15,287.04
|
| Rate for Payer: Kentucky WC Medicaid |
$14,667.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,344.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,813.14
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem Medicaid |
$284.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Humana KY Medicaid |
$284.75
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$287.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
PERMANENT NAIL REMOVAL
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$251.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.81
|
| Rate for Payer: Anthem Medicaid |
$81.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$828.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$270.66
|
| Rate for Payer: Healthspan PPO |
$238.86
|
| Rate for Payer: Humana Medicaid |
$81.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.12
|
| Rate for Payer: Molina Healthcare Passport |
$81.49
|
| Rate for Payer: Multiplan PHCS |
$496.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$579.60
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.30
|
|
|
PERMANENT NAIL REMOVAL
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
76100099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
PERMANENT NAIL REMOVAL(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761P0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$251.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.81
|
| Rate for Payer: Anthem Medicaid |
$81.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$270.66
|
| Rate for Payer: Healthspan PPO |
$238.86
|
| Rate for Payer: Humana Medicaid |
$81.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.12
|
| Rate for Payer: Molina Healthcare Passport |
$81.49
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.30
|
|
|
PERMANENT NAIL REMOVAL(T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761T0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
PERMANENT NAIL REMOVAL(T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 11750
|
| Hospital Charge Code |
761T0099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
|
PERMANENT PACEMAKER
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.60 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$840.20
|
| Rate for Payer: Anthem Medicaid |
$487.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$855.41
|
| Rate for Payer: Healthspan PPO |
$826.08
|
| Rate for Payer: Humana Medicaid |
$487.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$687.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.35
|
| Rate for Payer: Molina Healthcare Passport |
$487.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.48
|
|
|
PERMANENT PACEMAKER
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
PERMANENT PACEMAKER
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33207
|
| Hospital Charge Code |
76101243
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
