|
REMOVAL DUCT BREAST(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761P0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.63 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$412.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.63
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Healthspan PPO |
$463.94
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$174.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
|
|
REMOVAL DUCT BREAST(T
|
Facility
|
IP
|
$4,696.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761T0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.48 |
| Max. Negotiated Rate |
$4,508.16 |
| Rate for Payer: Aetna Commercial |
$3,615.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.88
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cigna Commercial |
$3,897.68
|
| Rate for Payer: First Health Commercial |
$4,461.20
|
| Rate for Payer: Humana Commercial |
$3,991.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.76
|
| Rate for Payer: PHCS Commercial |
$4,508.16
|
| Rate for Payer: United Healthcare All Payer |
$4,132.48
|
|
|
REMOVAL DUCT BREAST(T
|
Facility
|
OP
|
$4,696.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761T0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.48 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Aetna Commercial |
$3,615.92
|
| Rate for Payer: Anthem Medicaid |
$1,614.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cigna Commercial |
$3,897.68
|
| Rate for Payer: First Health Commercial |
$4,461.20
|
| Rate for Payer: Humana Commercial |
$3,991.60
|
| Rate for Payer: Humana KY Medicaid |
$1,614.95
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.76
|
| Rate for Payer: PHCS Commercial |
$4,508.16
|
| Rate for Payer: United Healthcare All Payer |
$4,132.48
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Anthem Medicaid |
$103.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$287.44
|
| Rate for Payer: Healthspan PPO |
$239.15
|
| Rate for Payer: Humana Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.95
|
| Rate for Payer: Molina Healthcare Passport |
$103.87
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.91
|
|
|
REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.33 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$627.67
|
| Rate for Payer: Anthem Medicaid |
$254.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$654.69
|
| Rate for Payer: Healthspan PPO |
$529.32
|
| Rate for Payer: Humana Medicaid |
$254.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.42
|
| Rate for Payer: Molina Healthcare Passport |
$254.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.87
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
REMOVAL FOREIGN BODY HAND
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$421.83
|
| Rate for Payer: Anthem Medicaid |
$145.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$458.81
|
| Rate for Payer: Healthspan PPO |
$382.09
|
| Rate for Payer: Humana Medicaid |
$145.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$371.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.13
|
| Rate for Payer: Molina Healthcare Passport |
$145.23
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.68
|
|
|
REMOVAL FOREIGN BODY HAND
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVAL FOREIGN BODY HAND
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVAL FOREIGN BODY HAND(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
761P0661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.23 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$421.83
|
| Rate for Payer: Anthem Medicaid |
$145.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$458.81
|
| Rate for Payer: Healthspan PPO |
$382.09
|
| Rate for Payer: Humana Medicaid |
$145.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$371.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.13
|
| Rate for Payer: Molina Healthcare Passport |
$145.23
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.68
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
REMOVAL FOREIGN BODY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
761P1126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.33 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$627.67
|
| Rate for Payer: Anthem Medicaid |
$254.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$654.69
|
| Rate for Payer: Healthspan PPO |
$529.32
|
| Rate for Payer: Humana Medicaid |
$254.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.42
|
| Rate for Payer: Molina Healthcare Passport |
$254.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.87
|
|
|
REMOVAL FOREIGN BODY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
761P1125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Anthem Medicaid |
$103.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$287.44
|
| Rate for Payer: Healthspan PPO |
$239.15
|
| Rate for Payer: Humana Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.95
|
| Rate for Payer: Molina Healthcare Passport |
$103.87
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.91
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$1,156.50
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.34 |
| Max. Negotiated Rate |
$1,110.24 |
| Rate for Payer: Aetna Commercial |
$890.50
|
| Rate for Payer: Anthem Medicaid |
$397.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna Commercial |
$959.90
|
| Rate for Payer: First Health Commercial |
$1,098.68
|
| Rate for Payer: Humana Commercial |
$983.02
|
| Rate for Payer: Humana KY Medicaid |
$397.72
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$401.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.72
|
| Rate for Payer: Ohio Health Group HMO |
$867.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.52
|
| Rate for Payer: PHCS Commercial |
$1,110.24
|
| Rate for Payer: United Healthcare All Payer |
$1,017.72
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$1,156.50
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Aetna Commercial |
$188.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.65
|
| Rate for Payer: Anthem Medicaid |
$75.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,156.50
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna Commercial |
$238.27
|
| Rate for Payer: Healthspan PPO |
$200.70
|
| Rate for Payer: Humana Medicaid |
$75.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.09
|
| Rate for Payer: Molina Healthcare Passport |
$75.58
|
| Rate for Payer: Multiplan PHCS |
$693.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.55
|
| Rate for Payer: UHCCP Medicaid |
$86.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.34
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$1,156.50
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.34 |
| Max. Negotiated Rate |
$1,110.24 |
| Rate for Payer: Aetna Commercial |
$890.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.07
|
| Rate for Payer: Cash Price |
$578.25
|
| Rate for Payer: Cigna Commercial |
$959.90
|
| Rate for Payer: First Health Commercial |
$1,098.68
|
| Rate for Payer: Humana Commercial |
$983.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$948.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.72
|
| Rate for Payer: Ohio Health Group HMO |
$867.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.52
|
| Rate for Payer: PHCS Commercial |
$1,110.24
|
| Rate for Payer: United Healthcare All Payer |
$1,017.72
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
45000263
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
45000263
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
REMOVAL FOREIGN BODY PHARYNX(P
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761P1703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$590.00 |
| Rate for Payer: Aetna Commercial |
$188.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.65
|
| Rate for Payer: Anthem Medicaid |
$75.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$238.27
|
| Rate for Payer: Healthspan PPO |
$200.70
|
| Rate for Payer: Humana Medicaid |
$75.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.09
|
| Rate for Payer: Molina Healthcare Passport |
$75.58
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.00
|
| Rate for Payer: UHCCP Medicaid |
$86.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.34
|
|
|
REMOVAL FOREIGN BODY PHARYNX(T
|
Facility
|
IP
|
$566.50
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761T1703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$543.84 |
| Rate for Payer: Aetna Commercial |
$436.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.87
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cigna Commercial |
$470.20
|
| Rate for Payer: First Health Commercial |
$538.18
|
| Rate for Payer: Humana Commercial |
$481.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.52
|
| Rate for Payer: Ohio Health Group HMO |
$424.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.62
|
| Rate for Payer: PHCS Commercial |
$543.84
|
| Rate for Payer: United Healthcare All Payer |
$498.52
|
|
|
REMOVAL FOREIGN BODY PHARYNX(T
|
Facility
|
OP
|
$566.50
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761T1703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.64 |
| Max. Negotiated Rate |
$543.84 |
| Rate for Payer: Aetna Commercial |
$436.20
|
| Rate for Payer: Anthem Medicaid |
$194.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cash Price |
$283.25
|
| Rate for Payer: Cigna Commercial |
$470.20
|
| Rate for Payer: First Health Commercial |
$538.18
|
| Rate for Payer: Humana Commercial |
$481.52
|
| Rate for Payer: Humana KY Medicaid |
$194.82
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.52
|
| Rate for Payer: Ohio Health Group HMO |
$424.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.62
|
| Rate for Payer: PHCS Commercial |
$543.84
|
| Rate for Payer: United Healthcare All Payer |
$498.52
|
|
