|
REMOVAL FOREIGN BODY THIGH/KNE
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
761P0828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$829.00 |
| Rate for Payer: Aetna Commercial |
$584.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$245.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$829.00
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$643.19
|
| Rate for Payer: Healthspan PPO |
$747.04
|
| Rate for Payer: Humana Medicaid |
$245.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.91
|
| Rate for Payer: Molina Healthcare Passport |
$245.99
|
| Rate for Payer: Multiplan PHCS |
$497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$580.30
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.45
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Facility
|
IP
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$795.84 |
| Rate for Payer: Aetna Commercial |
$638.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$646.62
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$688.07
|
| Rate for Payer: First Health Commercial |
$787.55
|
| Rate for Payer: Humana Commercial |
$704.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$729.52
|
| Rate for Payer: Ohio Health Group HMO |
$621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.99
|
| Rate for Payer: PHCS Commercial |
$795.84
|
| Rate for Payer: United Healthcare All Payer |
$729.52
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Facility
|
OP
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.77 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$638.33
|
| Rate for Payer: Anthem Medicaid |
$285.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$646.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$688.07
|
| Rate for Payer: First Health Commercial |
$787.55
|
| Rate for Payer: Humana Commercial |
$704.65
|
| Rate for Payer: Humana KY Medicaid |
$285.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$287.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$729.52
|
| Rate for Payer: Ohio Health Group HMO |
$621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.99
|
| Rate for Payer: PHCS Commercial |
$795.84
|
| Rate for Payer: United Healthcare All Payer |
$729.52
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$829.00 |
| Rate for Payer: Aetna Commercial |
$584.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$245.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$829.00
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$643.19
|
| Rate for Payer: Healthspan PPO |
$747.04
|
| Rate for Payer: Humana Medicaid |
$245.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.91
|
| Rate for Payer: Molina Healthcare Passport |
$245.99
|
| Rate for Payer: Multiplan PHCS |
$497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$580.30
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.45
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
|
|
REMOVAL IMP W/O CAPSULECTOMY
|
Professional
|
Both
|
$750.00
|
|
| Hospital Charge Code |
22200046
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| 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
|
|
|
REMOVAL INTRANASAL LESION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.50 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$461.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.52
|
| Rate for Payer: Anthem Medicaid |
$173.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$450.44
|
| Rate for Payer: Healthspan PPO |
$923.36
|
| Rate for Payer: Humana Medicaid |
$173.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.97
|
| Rate for Payer: Molina Healthcare Passport |
$173.50
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$186.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.24
|
|
|
REMOVAL INTRANASAL LESION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL INTRANASAL LESION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL INTRANASAL LESION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
761P1122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.50 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$461.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.52
|
| Rate for Payer: Anthem Medicaid |
$173.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$450.44
|
| Rate for Payer: Healthspan PPO |
$923.36
|
| Rate for Payer: Humana Medicaid |
$173.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.97
|
| Rate for Payer: Molina Healthcare Passport |
$173.50
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$186.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.24
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,141.54 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$2,091.87
|
| Rate for Payer: Anthem Medicaid |
$1,141.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,300.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$1,864.86
|
| Rate for Payer: Healthspan PPO |
$1,672.64
|
| Rate for Payer: Humana Medicaid |
$1,141.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,750.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,164.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,141.54
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,010.00
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,152.96
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
REMOVAL KIDNEY OPEN RADICAL(P
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
761P2046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,141.54 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$2,091.87
|
| Rate for Payer: Anthem Medicaid |
$1,141.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,300.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$1,864.86
|
| Rate for Payer: Healthspan PPO |
$1,672.64
|
| Rate for Payer: Humana Medicaid |
$1,141.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,750.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,164.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,141.54
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,010.00
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,152.96
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,115.00 |
| Rate for Payer: Anthem Medicaid |
$800.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$800.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$816.00
|
| Rate for Payer: Molina Healthcare Passport |
$800.00
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$808.00
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$482.37
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.55 |
| Max. Negotiated Rate |
$482.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REMOVAL OF ADENOIDS
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$351.01
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Healthspan PPO |
$296.01
|
| Rate for Payer: Humana Medicaid |
$173.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$311.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.80
|
| Rate for Payer: Molina Healthcare Passport |
$173.33
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.06
|
|
|
REMOVAL OF ADENOIDS(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
761P1712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$351.01
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Healthspan PPO |
$296.01
|
| Rate for Payer: Humana Medicaid |
$173.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$311.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.80
|
| Rate for Payer: Molina Healthcare Passport |
$173.33
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.06
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$741.25 |
| Rate for Payer: Aetna Commercial |
$614.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.73
|
| Rate for Payer: Anthem Medicaid |
$294.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$679.21
|
| Rate for Payer: Healthspan PPO |
$741.25
|
| Rate for Payer: Humana Medicaid |
$294.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$502.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.91
|
| Rate for Payer: Molina Healthcare Passport |
$294.03
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.50
|
| Rate for Payer: UHCCP Medicaid |
$225.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.97
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| 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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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 |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| 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 |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
