|
REMOVAL OF ANKLE/HEEL LESIO(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
761P0976
|
|
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 BLADDER STONE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF BLADDER STONE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.48
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF BLADDER STONE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.22 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$761.65
|
| Rate for Payer: Anthem Medicaid |
$385.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$671.31
|
| Rate for Payer: Healthspan PPO |
$609.01
|
| Rate for Payer: Humana Medicaid |
$385.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.92
|
| Rate for Payer: Molina Healthcare Passport |
$385.22
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.07
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Professional
|
Both
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$9,368.00 |
| Rate for Payer: Aetna Commercial |
$402.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.04
|
| Rate for Payer: Anthem Medicaid |
$233.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,368.00
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$749.45
|
| Rate for Payer: Healthspan PPO |
$547.59
|
| Rate for Payer: Humana Medicaid |
$233.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.30
|
| Rate for Payer: Molina Healthcare Passport |
$233.63
|
| Rate for Payer: Multiplan PHCS |
$5,620.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,557.60
|
| Rate for Payer: UHCCP Medicaid |
$139.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.97
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Professional
|
Both
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.98 |
| Max. Negotiated Rate |
$9,053.00 |
| Rate for Payer: Aetna Commercial |
$557.61
|
| Rate for Payer: Anthem Medicaid |
$349.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,053.00
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$975.78
|
| Rate for Payer: Healthspan PPO |
$505.08
|
| Rate for Payer: Humana Medicaid |
$349.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.98
|
| Rate for Payer: Molina Healthcare Passport |
$349.98
|
| Rate for Payer: Multiplan PHCS |
$5,431.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,337.10
|
| Rate for Payer: UHCCP Medicaid |
$3,168.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.48
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.89 |
| Max. Negotiated Rate |
$8,690.88 |
| Rate for Payer: Aetna Commercial |
$6,970.81
|
| Rate for Payer: Anthem Medicaid |
$3,113.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,061.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$7,513.99
|
| Rate for Payer: First Health Commercial |
$8,600.35
|
| Rate for Payer: Humana Commercial |
$7,695.05
|
| Rate for Payer: Humana KY Medicaid |
$3,113.33
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,145.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,423.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,681.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,175.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,966.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.43
|
| Rate for Payer: PHCS Commercial |
$8,690.88
|
| Rate for Payer: United Healthcare All Payer |
$7,966.64
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.89 |
| Max. Negotiated Rate |
$8,690.88 |
| Rate for Payer: Aetna Commercial |
$6,970.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,061.34
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$7,513.99
|
| Rate for Payer: First Health Commercial |
$8,600.35
|
| Rate for Payer: Humana Commercial |
$7,695.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,423.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,681.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,966.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.43
|
| Rate for Payer: PHCS Commercial |
$8,690.88
|
| Rate for Payer: United Healthcare All Payer |
$7,966.64
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,217.84 |
| Max. Negotiated Rate |
$8,993.28 |
| Rate for Payer: Aetna Commercial |
$7,213.36
|
| Rate for Payer: Anthem Medicaid |
$3,221.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$7,775.44
|
| Rate for Payer: First Health Commercial |
$8,899.60
|
| Rate for Payer: Humana Commercial |
$7,962.80
|
| Rate for Payer: Humana KY Medicaid |
$3,221.66
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.08
|
| Rate for Payer: PHCS Commercial |
$8,993.28
|
| Rate for Payer: United Healthcare All Payer |
$8,243.84
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,217.84 |
| Max. Negotiated Rate |
$8,993.28 |
| Rate for Payer: Aetna Commercial |
$7,213.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.04
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$7,775.44
|
| Rate for Payer: First Health Commercial |
$8,899.60
|
| Rate for Payer: Humana Commercial |
$7,962.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,873.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,217.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,904.08
|
| Rate for Payer: PHCS Commercial |
$8,993.28
|
| Rate for Payer: United Healthcare All Payer |
$8,243.84
|
|
|
REMOVAL OF BONE FOR GRAFT(P
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761P0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.75 |
| Max. Negotiated Rate |
$975.78 |
| Rate for Payer: Aetna Commercial |
$557.61
|
| Rate for Payer: Anthem Medicaid |
$349.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$485.00
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$975.78
|
| Rate for Payer: Healthspan PPO |
$505.08
|
| Rate for Payer: Humana Medicaid |
$349.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.98
|
| Rate for Payer: Molina Healthcare Passport |
$349.98
|
| Rate for Payer: Multiplan PHCS |
$291.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$339.50
|
| Rate for Payer: UHCCP Medicaid |
$169.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.48
|
|
|
REMOVAL OF BONE FOR GRAFT(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761P0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$402.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.04
|
| Rate for Payer: Anthem Medicaid |
$233.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$749.45
|
| Rate for Payer: Healthspan PPO |
$547.59
|
| Rate for Payer: Humana Medicaid |
$233.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.30
|
| Rate for Payer: Molina Healthcare Passport |
$233.63
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$139.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.97
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761T0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761T0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761T0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761T0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE LESION
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.97 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Aetna Commercial |
$1,010.00
|
| Rate for Payer: Anthem Medicaid |
$500.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,461.00
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,091.60
|
| Rate for Payer: Healthspan PPO |
$914.85
|
| Rate for Payer: Humana Medicaid |
$500.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.99
|
| Rate for Payer: Molina Healthcare Passport |
$500.97
|
| Rate for Payer: Multiplan PHCS |
$876.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.70
|
| Rate for Payer: UHCCP Medicaid |
$511.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.98
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$1,402.56 |
| Rate for Payer: Aetna Commercial |
$1,124.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,139.58
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,212.63
|
| Rate for Payer: First Health Commercial |
$1,387.95
|
| Rate for Payer: Humana Commercial |
$1,241.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,198.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,078.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,285.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.91
|
| Rate for Payer: PHCS Commercial |
$1,402.56
|
| Rate for Payer: United Healthcare All Payer |
$1,285.68
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.93 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,124.97
|
| Rate for Payer: Anthem Medicaid |
$502.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,139.58
|
| 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 |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,212.63
|
| Rate for Payer: First Health Commercial |
$1,387.95
|
| Rate for Payer: Humana Commercial |
$1,241.85
|
| Rate for Payer: Humana KY Medicaid |
$502.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$507.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,198.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,078.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,285.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.91
|
| Rate for Payer: PHCS Commercial |
$1,402.56
|
| Rate for Payer: United Healthcare All Payer |
$1,285.68
|
|
|
REMOVAL OF BONE LESION(P
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
761P0448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.97 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Aetna Commercial |
$1,010.00
|
| Rate for Payer: Anthem Medicaid |
$500.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,461.00
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,091.60
|
| Rate for Payer: Healthspan PPO |
$914.85
|
| Rate for Payer: Humana Medicaid |
$500.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.99
|
| Rate for Payer: Molina Healthcare Passport |
$500.97
|
| Rate for Payer: Multiplan PHCS |
$876.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.70
|
| Rate for Payer: UHCCP Medicaid |
$511.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.98
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem Medicaid |
$455.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| 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 |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Humana KY Medicaid |
$455.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$460.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$464.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.75
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.25 |
| Max. Negotiated Rate |
$1,272.00 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$265.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.75
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.34 |
| Max. Negotiated Rate |
$1,325.00 |
| Rate for Payer: Aetna Commercial |
$515.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$190.34
|
| Rate for Payer: Anthem Medicaid |
$219.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,325.00
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$572.15
|
| Rate for Payer: Healthspan PPO |
$666.12
|
| Rate for Payer: Humana Medicaid |
$219.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$447.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.60
|
| Rate for Payer: Molina Healthcare Passport |
$219.22
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$927.50
|
| Rate for Payer: UHCCP Medicaid |
$199.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.41
|
|
|
REMOVAL OF CERVIX
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
REMOVAL OF CERVIX
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Aetna Commercial |
$515.38
|
| Rate for Payer: Anthem Medicaid |
$245.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$503.93
|
| Rate for Payer: Healthspan PPO |
$499.02
|
| Rate for Payer: Humana Medicaid |
$245.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.39
|
| Rate for Payer: Molina Healthcare Passport |
$245.48
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$247.93
|
|
