|
PARTIAL REMOVAL OF FIBULA
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
76102884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.90 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.00 |
| Max. Negotiated Rate |
$1,180.80 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.70
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem Medicaid |
$423.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| 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 |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Humana KY Medicaid |
$423.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$427.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$431.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.70
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Ambetter Exchange |
$479.64
|
| Rate for Payer: Anthem Medicaid |
$305.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$479.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$479.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$575.57
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$803.12
|
| Rate for Payer: Healthspan PPO |
$656.15
|
| Rate for Payer: Humana Medicaid |
$305.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$479.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.04
|
| Rate for Payer: Molina Healthcare Passport |
$305.92
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.53
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$479.64
|
|
|
PARTIAL REMOVAL OF HAND BON(P
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
761P0683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Ambetter Exchange |
$479.64
|
| Rate for Payer: Anthem Medicaid |
$305.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$479.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$479.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$575.57
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$803.12
|
| Rate for Payer: Healthspan PPO |
$656.15
|
| Rate for Payer: Humana Medicaid |
$305.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$479.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.04
|
| Rate for Payer: Molina Healthcare Passport |
$305.92
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.53
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$479.64
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$278.22
|
| Rate for Payer: Ambetter Exchange |
$191.04
|
| Rate for Payer: Anthem Medicaid |
$128.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.25
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$271.91
|
| Rate for Payer: Healthspan PPO |
$269.39
|
| Rate for Payer: Humana Medicaid |
$128.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$191.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.90
|
| Rate for Payer: Molina Healthcare Passport |
$128.33
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.35
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.04
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
PARTIAL REMOVAL OF HYMEN(P
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
761P2163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$278.22
|
| Rate for Payer: Ambetter Exchange |
$191.04
|
| Rate for Payer: Anthem Medicaid |
$128.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.25
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$271.91
|
| Rate for Payer: Healthspan PPO |
$269.39
|
| Rate for Payer: Humana Medicaid |
$128.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$191.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.90
|
| Rate for Payer: Molina Healthcare Passport |
$128.33
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.35
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.04
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Facility
|
IP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$971.40 |
| Max. Negotiated Rate |
$3,108.48 |
| Rate for Payer: Aetna Commercial |
$2,493.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.64
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$2,687.54
|
| Rate for Payer: First Health Commercial |
$3,076.10
|
| Rate for Payer: Humana Commercial |
$2,752.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,655.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,817.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.22
|
| Rate for Payer: PHCS Commercial |
$3,108.48
|
| Rate for Payer: United Healthcare All Payer |
$2,849.44
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$971.40 |
| Max. Negotiated Rate |
$3,108.48 |
| Rate for Payer: Aetna Commercial |
$2,493.26
|
| Rate for Payer: Anthem Medicaid |
$1,113.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.64
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$2,687.54
|
| Rate for Payer: First Health Commercial |
$3,076.10
|
| Rate for Payer: Humana Commercial |
$2,752.30
|
| Rate for Payer: Humana KY Medicaid |
$1,113.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,124.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,655.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,135.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,590.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,817.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.22
|
| Rate for Payer: PHCS Commercial |
$3,108.48
|
| Rate for Payer: United Healthcare All Payer |
$2,849.44
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Professional
|
Both
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,064.37 |
| Max. Negotiated Rate |
$2,155.89 |
| Rate for Payer: Aetna Commercial |
$2,155.89
|
| Rate for Payer: Ambetter Exchange |
$1,253.37
|
| Rate for Payer: Anthem Medicaid |
$1,064.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,253.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,253.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,504.04
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$1,912.83
|
| Rate for Payer: Healthspan PPO |
$1,723.83
|
| Rate for Payer: Humana Medicaid |
$1,064.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,806.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,253.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,085.66
|
| Rate for Payer: Molina Healthcare Passport |
$1,064.37
|
| Rate for Payer: Multiplan PHCS |
$1,942.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,629.38
|
| Rate for Payer: UHCCP Medicaid |
$1,133.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,075.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,253.37
|
|
|
PARTIAL REMOVAL OF PENIS
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$1,022.83 |
| Rate for Payer: Aetna Commercial |
$1,022.83
|
| Rate for Payer: Ambetter Exchange |
$599.56
|
| Rate for Payer: Anthem Medicaid |
$459.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$599.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$599.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$719.47
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$904.94
|
| Rate for Payer: Healthspan PPO |
$990.36
|
| Rate for Payer: Humana Medicaid |
$459.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$860.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$599.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.93
|
| Rate for Payer: Molina Healthcare Passport |
$459.74
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$779.43
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$599.56
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| 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 |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$211.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$213.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
76100590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
76100592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
76100590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.22 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem Medicaid |
$495.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| 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 |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Humana KY Medicaid |
$495.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$500.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
76100592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.66 |
| Max. Negotiated Rate |
$732.28 |
| Rate for Payer: Aetna Commercial |
$626.51
|
| Rate for Payer: Ambetter Exchange |
$416.41
|
| Rate for Payer: Anthem Medicaid |
$312.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.69
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$732.28
|
| Rate for Payer: Healthspan PPO |
$567.49
|
| Rate for Payer: Humana Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$318.91
|
| Rate for Payer: Molina Healthcare Passport |
$312.66
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.33
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.41
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
76100592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| 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 |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$373.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
76100590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.31 |
| Max. Negotiated Rate |
$1,257.56 |
| Rate for Payer: Aetna Commercial |
$924.55
|
| Rate for Payer: Ambetter Exchange |
$560.10
|
| Rate for Payer: Anthem Medicaid |
$380.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$560.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$672.12
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,257.56
|
| Rate for Payer: Healthspan PPO |
$837.45
|
| Rate for Payer: Humana Medicaid |
$380.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$560.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.92
|
| Rate for Payer: Molina Healthcare Passport |
$380.31
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.13
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$560.10
|
|
|
PARTIAL REMOVAL OF RADIUS(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25230
|
| Hospital Charge Code |
761P0592
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.66 |
| Max. Negotiated Rate |
$732.28 |
| Rate for Payer: Aetna Commercial |
$626.51
|
| Rate for Payer: Ambetter Exchange |
$416.41
|
| Rate for Payer: Anthem Medicaid |
$312.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.69
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$732.28
|
| Rate for Payer: Healthspan PPO |
$567.49
|
| Rate for Payer: Humana Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$530.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$318.91
|
| Rate for Payer: Molina Healthcare Passport |
$312.66
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.33
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.41
|
|
|
PARTIAL REMOVAL OF RADIUS(P
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
761P0590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.31 |
| Max. Negotiated Rate |
$1,257.56 |
| Rate for Payer: Aetna Commercial |
$924.55
|
| Rate for Payer: Ambetter Exchange |
$560.10
|
| Rate for Payer: Anthem Medicaid |
$380.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$560.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$672.12
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,257.56
|
| Rate for Payer: Healthspan PPO |
$837.45
|
| Rate for Payer: Humana Medicaid |
$380.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$560.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.92
|
| Rate for Payer: Molina Healthcare Passport |
$380.31
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.13
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$560.10
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 45111
|
| Hospital Charge Code |
76101878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$1,568.16 |
| Rate for Payer: Aetna Commercial |
$1,568.16
|
| Rate for Payer: Ambetter Exchange |
$1,026.13
|
| Rate for Payer: Anthem Medicaid |
$815.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,231.36
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,460.43
|
| Rate for Payer: Healthspan PPO |
$1,322.46
|
| Rate for Payer: Humana Medicaid |
$815.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,386.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$831.78
|
| Rate for Payer: Molina Healthcare Passport |
$815.47
|
| Rate for Payer: Multiplan PHCS |
$783.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,333.97
|
| Rate for Payer: UHCCP Medicaid |
$456.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$823.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.13
|
|
|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 45111
|
| Hospital Charge Code |
76101878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,252.80 |
| Rate for Payer: Aetna Commercial |
$1,004.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.90
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,083.15
|
| Rate for Payer: First Health Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial |
$1,109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,070.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$963.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.45
|
| Rate for Payer: PHCS Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare All Payer |
$1,148.40
|
|
