|
REMOVAL OF CERVIX
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| 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: 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 |
$295.50
|
| 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(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
761P2205
|
|
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
|
|
|
REMOVAL OF CHEST TUBE
|
Professional
|
Both
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.17 |
| Max. Negotiated Rate |
$5,030.00 |
| Rate for Payer: Aetna Commercial |
$303.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.17
|
| Rate for Payer: Anthem Medicaid |
$148.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,030.00
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$279.25
|
| Rate for Payer: Healthspan PPO |
$710.48
|
| Rate for Payer: Humana Medicaid |
$148.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.03
|
| Rate for Payer: Molina Healthcare Passport |
$148.07
|
| Rate for Payer: Multiplan PHCS |
$3,018.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,521.00
|
| Rate for Payer: UHCCP Medicaid |
$142.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.55
|
|
|
REMOVAL OF CHEST TUBE
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.90 |
| Max. Negotiated Rate |
$4,828.80 |
| Rate for Payer: Aetna Commercial |
$3,873.10
|
| Rate for Payer: Anthem Medicaid |
$1,729.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,923.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$4,174.90
|
| Rate for Payer: First Health Commercial |
$4,778.50
|
| Rate for Payer: Humana Commercial |
$4,275.50
|
| Rate for Payer: Humana KY Medicaid |
$1,729.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,747.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,712.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,764.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,426.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,559.30
|
| Rate for Payer: PHCS Commercial |
$4,828.80
|
| Rate for Payer: United Healthcare All Payer |
$4,426.40
|
|
|
REMOVAL OF CHEST TUBE
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.90 |
| Max. Negotiated Rate |
$4,828.80 |
| Rate for Payer: Aetna Commercial |
$3,873.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,923.40
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$4,174.90
|
| Rate for Payer: First Health Commercial |
$4,778.50
|
| Rate for Payer: Humana Commercial |
$4,275.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,712.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,509.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,426.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,559.30
|
| Rate for Payer: PHCS Commercial |
$4,828.80
|
| Rate for Payer: United Healthcare All Payer |
$4,426.40
|
|
|
REMOVAL OF CHEST TUBE(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761P1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.17 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$303.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.17
|
| Rate for Payer: Anthem Medicaid |
$148.07
|
| 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 |
$279.25
|
| Rate for Payer: Healthspan PPO |
$710.48
|
| Rate for Payer: Humana Medicaid |
$148.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.03
|
| Rate for Payer: Molina Healthcare Passport |
$148.07
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$142.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.55
|
|
|
REMOVAL OF CHEST TUBE(T
|
Facility
|
IP
|
$4,180.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761T1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.40 |
| Max. Negotiated Rate |
$4,012.80 |
| Rate for Payer: Aetna Commercial |
$3,218.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.40
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cigna Commercial |
$3,469.40
|
| Rate for Payer: First Health Commercial |
$3,971.00
|
| Rate for Payer: Humana Commercial |
$3,553.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.80
|
| Rate for Payer: PHCS Commercial |
$4,012.80
|
| Rate for Payer: United Healthcare All Payer |
$3,678.40
|
|
|
REMOVAL OF CHEST TUBE(T
|
Facility
|
OP
|
$4,180.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761T1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.40 |
| Max. Negotiated Rate |
$4,012.80 |
| Rate for Payer: Aetna Commercial |
$3,218.60
|
| Rate for Payer: Anthem Medicaid |
$1,437.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cigna Commercial |
$3,469.40
|
| Rate for Payer: First Health Commercial |
$3,971.00
|
| Rate for Payer: Humana Commercial |
$3,553.00
|
| Rate for Payer: Humana KY Medicaid |
$1,437.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,452.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,466.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.80
|
| Rate for Payer: PHCS Commercial |
$4,012.80
|
| Rate for Payer: United Healthcare All Payer |
$3,678.40
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.25 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.75
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.45 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,038.92
|
| Rate for Payer: Anthem Medicaid |
$526.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.49
|
| Rate for Payer: Healthspan PPO |
$1,021.46
|
| Rate for Payer: Humana Medicaid |
$526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.98
|
| Rate for Payer: Molina Healthcare Passport |
$526.45
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.71
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.13 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,671.63
|
| Rate for Payer: Anthem Medicaid |
$639.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,601.22
|
| Rate for Payer: Healthspan PPO |
$1,643.54
|
| Rate for Payer: Humana Medicaid |
$639.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,297.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$651.91
|
| Rate for Payer: Molina Healthcare Passport |
$639.13
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.52
|
|
|
REMOVAL OF CLOT IN GRAFT(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
761P1424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.13 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$1,671.63
|
| Rate for Payer: Anthem Medicaid |
$639.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,601.22
|
| Rate for Payer: Healthspan PPO |
$1,643.54
|
| Rate for Payer: Humana Medicaid |
$639.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,297.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$651.91
|
| Rate for Payer: Molina Healthcare Passport |
$639.13
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.52
|
|
|
REMOVAL OF CLOT IN GRAFT(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
761P1423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.45 |
| Max. Negotiated Rate |
$1,825.00 |
| Rate for Payer: Aetna Commercial |
$1,038.92
|
| Rate for Payer: Anthem Medicaid |
$526.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,825.00
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.49
|
| Rate for Payer: Healthspan PPO |
$1,021.46
|
| Rate for Payer: Humana Medicaid |
$526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.98
|
| Rate for Payer: Molina Healthcare Passport |
$526.45
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.50
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.71
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
761P1823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,787.41
|
| Rate for Payer: Anthem Medicaid |
$812.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,662.37
|
| Rate for Payer: Healthspan PPO |
$1,507.36
|
| Rate for Payer: Humana Medicaid |
$812.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,583.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$828.48
|
| Rate for Payer: Molina Healthcare Passport |
$812.24
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$820.36
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
76101823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,787.41
|
| Rate for Payer: Anthem Medicaid |
$812.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,662.37
|
| Rate for Payer: Healthspan PPO |
$1,507.36
|
| Rate for Payer: Humana Medicaid |
$812.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,583.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$828.48
|
| Rate for Payer: Molina Healthcare Passport |
$812.24
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$820.36
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
76101823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
76101823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.90
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,664.75
|
| Rate for Payer: Humana Commercial |
$2,384.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.55
|
| Rate for Payer: PHCS Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Payer |
$2,468.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.65 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Anthem Medicaid |
$964.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.90
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,664.75
|
| Rate for Payer: Humana Commercial |
$2,384.25
|
| Rate for Payer: Humana KY Medicaid |
$964.64
|
| Rate for Payer: Kentucky WC Medicaid |
$974.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$983.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.55
|
| Rate for Payer: PHCS Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Payer |
$2,468.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,017.90 |
| Max. Negotiated Rate |
$7,516.80 |
| Rate for Payer: Aetna Commercial |
$6,029.10
|
| Rate for Payer: Anthem Medicaid |
$2,692.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,107.40
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$6,498.90
|
| Rate for Payer: First Health Commercial |
$7,438.50
|
| Rate for Payer: Humana Commercial |
$6,655.50
|
| Rate for Payer: Humana KY Medicaid |
$2,692.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,720.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,420.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,778.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,746.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,890.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,872.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.30
|
| Rate for Payer: PHCS Commercial |
$7,516.80
|
| Rate for Payer: United Healthcare All Payer |
$6,890.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,017.90 |
| Max. Negotiated Rate |
$7,516.80 |
| Rate for Payer: Aetna Commercial |
$6,029.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,107.40
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$6,498.90
|
| Rate for Payer: First Health Commercial |
$7,438.50
|
| Rate for Payer: Humana Commercial |
$6,655.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,420.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,778.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,890.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,872.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.30
|
| Rate for Payer: PHCS Commercial |
$7,516.80
|
| Rate for Payer: United Healthcare All Payer |
$6,890.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$981.75 |
| Max. Negotiated Rate |
$3,850.15 |
| Rate for Payer: Aetna Commercial |
$3,850.15
|
| Rate for Payer: Anthem Medicaid |
$1,509.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,805.00
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$3,615.74
|
| Rate for Payer: Healthspan PPO |
$3,246.90
|
| Rate for Payer: Humana Medicaid |
$1,509.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,362.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,539.22
|
| Rate for Payer: Molina Healthcare Passport |
$1,509.04
|
| Rate for Payer: Multiplan PHCS |
$1,683.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,963.50
|
| Rate for Payer: UHCCP Medicaid |
$981.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,524.13
|
|
