|
RECOVERY IVC FILTER
|
Facility
|
OP
|
$8,091.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,427.53 |
| Max. Negotiated Rate |
$7,768.08 |
| Rate for Payer: Aetna Commercial |
$6,230.65
|
| Rate for Payer: Anthem Medicaid |
$2,782.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.56
|
| Rate for Payer: Cash Price |
$4,045.88
|
| Rate for Payer: Cigna Commercial |
$6,716.15
|
| Rate for Payer: First Health Commercial |
$7,687.16
|
| Rate for Payer: Humana Commercial |
$6,877.99
|
| Rate for Payer: Humana KY Medicaid |
$2,782.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,120.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,068.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,039.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.31
|
| Rate for Payer: PHCS Commercial |
$7,768.08
|
| Rate for Payer: United Healthcare All Payer |
$7,120.74
|
|
|
RECOVERY IVC FILTER
|
Facility
|
IP
|
$8,091.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,427.53 |
| Max. Negotiated Rate |
$7,768.08 |
| Rate for Payer: Aetna Commercial |
$6,230.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,311.56
|
| Rate for Payer: Cash Price |
$4,045.88
|
| Rate for Payer: Cigna Commercial |
$6,716.15
|
| Rate for Payer: First Health Commercial |
$7,687.16
|
| Rate for Payer: Humana Commercial |
$6,877.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,971.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,120.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,068.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,473.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,039.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,583.31
|
| Rate for Payer: PHCS Commercial |
$7,768.08
|
| Rate for Payer: United Healthcare All Payer |
$7,120.74
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
RECTAL FISTULA W/THROMBIN,GLUE
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
|
|
RECTUM SURGERY PROCEDURE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
|
|
RECTUM SURGERY PROCEDURE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
761P2612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$217.00
|
| Rate for Payer: UHCCP Medicaid |
$108.50
|
|
|
RECTUM SURGERY PROCEDURE
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
RECTUM SURGERY PROCEDURE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 45999
|
| Hospital Charge Code |
76102612
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.61 |
| Max. Negotiated Rate |
$1,179.36 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$842.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,179.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,137.24
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Humana Medicare Advantage |
$842.40
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
RED CELLS LR DEGLYCEROLIZED
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
38000014
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$288.88 |
| Max. Negotiated Rate |
$845.66 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$845.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.45
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$604.04
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$724.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
RED CELLS LR DEGLYCEROLIZED
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
38000014
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REDDICK SCOOP TP CHOL CATH 50C
|
Facility
|
IP
|
$2,042.18
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.65 |
| Max. Negotiated Rate |
$1,960.49 |
| Rate for Payer: Aetna Commercial |
$1,572.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.90
|
| Rate for Payer: Cash Price |
$1,021.09
|
| Rate for Payer: Cigna Commercial |
$1,695.01
|
| Rate for Payer: First Health Commercial |
$1,940.07
|
| Rate for Payer: Humana Commercial |
$1,735.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,507.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,797.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.10
|
| Rate for Payer: PHCS Commercial |
$1,960.49
|
| Rate for Payer: United Healthcare All Payer |
$1,797.12
|
|
|
REDDICK SCOOP TP CHOL CATH 50C
|
Facility
|
OP
|
$2,042.18
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.65 |
| Max. Negotiated Rate |
$1,960.49 |
| Rate for Payer: Aetna Commercial |
$1,572.48
|
| Rate for Payer: Anthem Medicaid |
$702.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.90
|
| Rate for Payer: Cash Price |
$1,021.09
|
| Rate for Payer: Cigna Commercial |
$1,695.01
|
| Rate for Payer: First Health Commercial |
$1,940.07
|
| Rate for Payer: Humana Commercial |
$1,735.85
|
| Rate for Payer: Humana KY Medicaid |
$702.31
|
| Rate for Payer: Kentucky WC Medicaid |
$709.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,507.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,797.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,776.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,409.10
|
| Rate for Payer: PHCS Commercial |
$1,960.49
|
| Rate for Payer: United Healthcare All Payer |
$1,797.12
|
|
|
REDO COMPL CARDIAC ANOMALY
|
Facility
|
IP
|
$3,932.93
|
|
|
Service Code
|
HCPCS 33622
|
| Hospital Charge Code |
76101316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,179.88 |
| Max. Negotiated Rate |
$3,775.61 |
| Rate for Payer: Aetna Commercial |
$3,028.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.69
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cigna Commercial |
$3,264.33
|
| Rate for Payer: First Health Commercial |
$3,736.28
|
| Rate for Payer: Humana Commercial |
$3,342.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,421.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.72
|
| Rate for Payer: PHCS Commercial |
$3,775.61
|
| Rate for Payer: United Healthcare All Payer |
$3,460.98
|
|
|
REDO COMPL CARDIAC ANOMALY
|
Professional
|
Both
|
$3,932.93
|
|
|
Service Code
|
HCPCS 33622
|
| Hospital Charge Code |
76101316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.53 |
| Max. Negotiated Rate |
$6,720.19 |
| Rate for Payer: Aetna Commercial |
$6,434.32
|
| Rate for Payer: Ambetter Exchange |
$3,219.92
|
| Rate for Payer: Anthem Medicaid |
$3,180.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,219.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,219.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,863.90
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cigna Commercial |
$6,720.19
|
| Rate for Payer: Healthspan PPO |
$4,743.73
|
| Rate for Payer: Humana Medicaid |
$3,180.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,907.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,219.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,243.63
|
| Rate for Payer: Molina Healthcare Passport |
$3,180.03
|
| Rate for Payer: Multiplan PHCS |
$2,359.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,185.90
|
| Rate for Payer: UHCCP Medicaid |
$1,376.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,211.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,219.92
|
|
|
REDO COMPL CARDIAC ANOMALY
|
Facility
|
OP
|
$3,932.93
|
|
|
Service Code
|
HCPCS 33622
|
| Hospital Charge Code |
76101316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,179.88 |
| Max. Negotiated Rate |
$3,775.61 |
| Rate for Payer: Aetna Commercial |
$3,028.36
|
| Rate for Payer: Anthem Medicaid |
$1,352.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.69
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cigna Commercial |
$3,264.33
|
| Rate for Payer: First Health Commercial |
$3,736.28
|
| Rate for Payer: Humana Commercial |
$3,342.99
|
| Rate for Payer: Humana KY Medicaid |
$1,352.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,421.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.72
|
| Rate for Payer: PHCS Commercial |
$3,775.61
|
| Rate for Payer: United Healthcare All Payer |
$3,460.98
|
|
|
REDO COMPL CARDIAC ANOMALY(P
|
Professional
|
Both
|
$3,932.93
|
|
|
Service Code
|
HCPCS 33622
|
| Hospital Charge Code |
761P1316
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,376.53 |
| Max. Negotiated Rate |
$6,720.19 |
| Rate for Payer: Aetna Commercial |
$6,434.32
|
| Rate for Payer: Ambetter Exchange |
$3,219.92
|
| Rate for Payer: Anthem Medicaid |
$3,180.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3,219.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,219.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,863.90
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cash Price |
$1,966.46
|
| Rate for Payer: Cigna Commercial |
$6,720.19
|
| Rate for Payer: Healthspan PPO |
$4,743.73
|
| Rate for Payer: Humana Medicaid |
$3,180.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,907.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3,219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,219.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,243.63
|
| Rate for Payer: Molina Healthcare Passport |
$3,180.03
|
| Rate for Payer: Multiplan PHCS |
$2,359.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,185.90
|
| Rate for Payer: UHCCP Medicaid |
$1,376.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,211.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$3,219.92
|
|
|
REDUC ELBOW,DISLOC/DIS HUMERUS
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
REDUC ELBOW,DISLOC/DIS HUMERUS
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
|
|
REDUC ELBOW,DISLOC/DIS HUMERUS
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
REDUCE TESTIS TORSION
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
76102796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.25 |
| Max. Negotiated Rate |
$732.79 |
| Rate for Payer: Aetna Commercial |
$732.79
|
| Rate for Payer: Ambetter Exchange |
$429.29
|
| Rate for Payer: Anthem Medicaid |
$328.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$429.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$429.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$515.15
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$647.55
|
| Rate for Payer: Healthspan PPO |
$709.53
|
| Rate for Payer: Humana Medicaid |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$615.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$429.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.53
|
| Rate for Payer: Molina Healthcare Passport |
$328.95
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$558.08
|
| Rate for Payer: UHCCP Medicaid |
$166.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$429.29
|
|
|
REDUCE TESTIS TORSION
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
76102796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
REDUCE TESTIS TORSION
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 54600
|
| Hospital Charge Code |
76102796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| 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 |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$165.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.75
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
REDUCTION MAMMOPLASTY
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.81 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,684.69
|
| Rate for Payer: Ambetter Exchange |
$1,034.80
|
| Rate for Payer: Anthem Medicaid |
$829.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,034.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,034.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,241.76
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$1,614.17
|
| Rate for Payer: Healthspan PPO |
$1,347.06
|
| Rate for Payer: Humana Medicaid |
$829.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,439.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,034.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$846.41
|
| Rate for Payer: Molina Healthcare Passport |
$829.81
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,345.24
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$838.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,034.80
|
|
|
REDUCTION MAMMOPLASTY
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,031.70 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Humana Medicare Advantage |
$6,025.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,230.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
