|
PART COLECTOMY LOW PELV ANAS
|
Facility
|
IP
|
$2,650.00
|
|
|
Service Code
|
HCPCS 44145
|
| Hospital Charge Code |
76101818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$2,544.00 |
| Rate for Payer: Aetna Commercial |
$2,040.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,067.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,199.50
|
| Rate for Payer: First Health Commercial |
$2,517.50
|
| Rate for Payer: Humana Commercial |
$2,252.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,173.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,955.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$795.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,332.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,828.50
|
| Rate for Payer: PHCS Commercial |
$2,544.00
|
| Rate for Payer: United Healthcare All Payer |
$2,332.00
|
|
|
PART COLECTOMY LOW PELV ANAS
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 44145
|
| Hospital Charge Code |
76101818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.50 |
| Max. Negotiated Rate |
$2,421.46 |
| Rate for Payer: Aetna Commercial |
$2,421.46
|
| Rate for Payer: Ambetter Exchange |
$1,561.66
|
| Rate for Payer: Anthem Medicaid |
$1,047.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,561.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,561.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,873.99
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,276.30
|
| Rate for Payer: Healthspan PPO |
$2,042.06
|
| Rate for Payer: Humana Medicaid |
$1,047.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,123.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,561.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,068.62
|
| Rate for Payer: Molina Healthcare Passport |
$1,047.67
|
| Rate for Payer: Multiplan PHCS |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,030.16
|
| Rate for Payer: UHCCP Medicaid |
$927.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,058.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,561.66
|
|
|
PART COLECTOMY LOW PELV ANAS(P
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 44145
|
| Hospital Charge Code |
761P1818
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.50 |
| Max. Negotiated Rate |
$2,421.46 |
| Rate for Payer: Aetna Commercial |
$2,421.46
|
| Rate for Payer: Ambetter Exchange |
$1,561.66
|
| Rate for Payer: Anthem Medicaid |
$1,047.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,561.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,561.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,873.99
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cash Price |
$1,325.00
|
| Rate for Payer: Cigna Commercial |
$2,276.30
|
| Rate for Payer: Healthspan PPO |
$2,042.06
|
| Rate for Payer: Humana Medicaid |
$1,047.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,123.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,561.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,068.62
|
| Rate for Payer: Molina Healthcare Passport |
$1,047.67
|
| Rate for Payer: Multiplan PHCS |
$1,590.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,030.16
|
| Rate for Payer: UHCCP Medicaid |
$927.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,058.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,561.66
|
|
|
PARTIAL COLECT W ANASMAT
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
76101828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,247.02 |
| Rate for Payer: Aetna Commercial |
$2,247.02
|
| Rate for Payer: Ambetter Exchange |
$1,453.87
|
| Rate for Payer: Anthem Medicaid |
$1,037.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,453.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,453.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,108.00
|
| Rate for Payer: Healthspan PPO |
$1,894.95
|
| Rate for Payer: Humana Medicaid |
$1,037.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,969.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,058.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,037.52
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.03
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,047.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,453.87
|
|
|
PARTIAL COLECT W ANASMAT
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
76101828
|
|
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
|
|
|
PARTIAL COLECT W ANASMAT
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
76101828
|
|
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
|
|
|
PARTIAL COLECT W ANASMAT(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44204
|
| Hospital Charge Code |
761P1828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,247.02 |
| Rate for Payer: Aetna Commercial |
$2,247.02
|
| Rate for Payer: Ambetter Exchange |
$1,453.87
|
| Rate for Payer: Anthem Medicaid |
$1,037.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,453.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,453.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,744.64
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,108.00
|
| Rate for Payer: Healthspan PPO |
$1,894.95
|
| Rate for Payer: Humana Medicaid |
$1,037.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,969.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,058.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,037.52
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.03
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,047.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,453.87
|
|
|
PARTIAL ESOPHAGECTOMY - DISTA
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
HCPCS 43117
|
| Hospital Charge Code |
76101721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
PARTIAL ESOPHAGECTOMY - DISTA
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
HCPCS 43117
|
| Hospital Charge Code |
76101721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem Medicaid |
$1,960.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Humana KY Medicaid |
$1,960.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,980.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,999.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
PARTIAL ESOPHAGECTOMY - DISTA
|
Professional
|
Both
|
$5,700.00
|
|
|
Service Code
|
HCPCS 43117
|
| Hospital Charge Code |
76101721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,629.11 |
| Max. Negotiated Rate |
$3,989.69 |
| Rate for Payer: Aetna Commercial |
$3,768.15
|
| Rate for Payer: Ambetter Exchange |
$3,068.99
|
| Rate for Payer: Anthem Medicaid |
$1,629.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,068.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,068.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,682.79
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$3,530.26
|
| Rate for Payer: Healthspan PPO |
$3,177.75
|
| Rate for Payer: Humana Medicaid |
$1,629.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,275.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,068.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,661.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,629.11
|
| Rate for Payer: Multiplan PHCS |
$3,420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,989.69
|
| Rate for Payer: UHCCP Medicaid |
$1,995.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,645.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,068.99
|
|
|
PARTIAL ESOPHAGECTOMY - DIST(P
|
Professional
|
Both
|
$5,700.00
|
|
|
Service Code
|
HCPCS 43117
|
| Hospital Charge Code |
761P1721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,629.11 |
| Max. Negotiated Rate |
$3,989.69 |
| Rate for Payer: Aetna Commercial |
$3,768.15
|
| Rate for Payer: Ambetter Exchange |
$3,068.99
|
| Rate for Payer: Anthem Medicaid |
$1,629.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,068.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,068.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,682.79
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$3,530.26
|
| Rate for Payer: Healthspan PPO |
$3,177.75
|
| Rate for Payer: Humana Medicaid |
$1,629.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,275.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,068.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,068.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,661.69
|
| Rate for Payer: Molina Healthcare Passport |
$1,629.11
|
| Rate for Payer: Multiplan PHCS |
$3,420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,989.69
|
| Rate for Payer: UHCCP Medicaid |
$1,995.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,645.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,068.99
|
|
|
PARTIAL EXCISION
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 24147
|
| Hospital Charge Code |
76100511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
PARTIAL EXCISION
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 24147
|
| Hospital Charge Code |
76100511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$1,055.04 |
| Rate for Payer: Aetna Commercial |
$909.51
|
| Rate for Payer: Ambetter Exchange |
$599.99
|
| Rate for Payer: Anthem Medicaid |
$408.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$599.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$719.99
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,055.04
|
| Rate for Payer: Healthspan PPO |
$823.82
|
| Rate for Payer: Humana Medicaid |
$408.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.12
|
| Rate for Payer: Molina Healthcare Passport |
$408.94
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$779.99
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$413.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$599.99
|
|
|
PARTIAL EXCISION
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 23180
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$825.60 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
PARTIAL EXCISION
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 24147
|
| Hospital Charge Code |
76100511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
PARTIAL EXCISION
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 23180
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,156.53 |
| Rate for Payer: Aetna Commercial |
$999.81
|
| Rate for Payer: Ambetter Exchange |
$658.74
|
| Rate for Payer: Anthem Medicaid |
$361.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$658.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$658.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$790.49
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,156.53
|
| Rate for Payer: Healthspan PPO |
$905.61
|
| Rate for Payer: Humana Medicaid |
$361.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$839.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$658.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.30
|
| Rate for Payer: Molina Healthcare Passport |
$361.08
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.36
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$658.74
|
|
|
PARTIAL EXCISION
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 23180
|
| Hospital Charge Code |
76100450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Humana KY Medicaid |
$295.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$298.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
PARTIAL EXCISION BONE PHALANX
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 28124
|
| Hospital Charge Code |
51000291
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$1,713.00 |
| Rate for Payer: Aetna Commercial |
$510.15
|
| Rate for Payer: Ambetter Exchange |
$318.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.05
|
| Rate for Payer: Anthem Medicaid |
$248.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.36
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cash Price |
$1,427.50
|
| Rate for Payer: Cigna Commercial |
$557.08
|
| Rate for Payer: Healthspan PPO |
$593.95
|
| Rate for Payer: Humana Medicaid |
$248.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$253.01
|
| Rate for Payer: Molina Healthcare Passport |
$248.05
|
| Rate for Payer: Multiplan PHCS |
$1,713.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$414.22
|
| Rate for Payer: UHCCP Medicaid |
$177.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$250.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.63
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 27641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECRANON PROCESS
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 24147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
PARTIAL EXCISION (P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 24147
|
| Hospital Charge Code |
761P0511
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$1,055.04 |
| Rate for Payer: Aetna Commercial |
$909.51
|
| Rate for Payer: Ambetter Exchange |
$599.99
|
| Rate for Payer: Anthem Medicaid |
$408.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$599.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$719.99
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,055.04
|
| Rate for Payer: Healthspan PPO |
$823.82
|
| Rate for Payer: Humana Medicaid |
$408.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$599.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$417.12
|
| Rate for Payer: Molina Healthcare Passport |
$408.94
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$779.99
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$413.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$599.99
|
|
|
PARTIAL EXCISION(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 23180
|
| Hospital Charge Code |
761P0450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,156.53 |
| Rate for Payer: Aetna Commercial |
$999.81
|
| Rate for Payer: Ambetter Exchange |
$658.74
|
| Rate for Payer: Anthem Medicaid |
$361.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$658.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$658.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$790.49
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,156.53
|
| Rate for Payer: Healthspan PPO |
$905.61
|
| Rate for Payer: Humana Medicaid |
$361.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$839.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$658.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.30
|
| Rate for Payer: Molina Healthcare Passport |
$361.08
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$856.36
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$658.74
|
|
