|
REDUCTION MAMMOPLASTY
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| 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: 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 |
$900.00
|
| 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
|
|
|
REDUCTION MAMMOPLASTY(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 19318
|
| Hospital Charge Code |
761P0307
|
|
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 OF ELBOW
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
45000122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REDUCTION OF ELBOW
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
45000122
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REDUCTION OF ELBOW
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
76100551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REDUCTION OF ELBOW
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
76100551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| 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 |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REDUCTION OF ELBOW
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
76100551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$456.62
|
| Rate for Payer: Ambetter Exchange |
$333.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$178.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$400.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$576.34
|
| Rate for Payer: Healthspan PPO |
$450.44
|
| Rate for Payer: Humana Medicaid |
$178.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.91
|
| Rate for Payer: Molina Healthcare Passport |
$178.34
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.88
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.75
|
|
|
REDUCTION OF ELBOW(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
761P0551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$576.34 |
| Rate for Payer: Aetna Commercial |
$456.62
|
| Rate for Payer: Ambetter Exchange |
$333.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$178.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$333.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$333.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$400.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$576.34
|
| Rate for Payer: Healthspan PPO |
$450.44
|
| Rate for Payer: Humana Medicaid |
$178.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$333.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$333.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.91
|
| Rate for Payer: Molina Healthcare Passport |
$178.34
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$433.88
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$333.75
|
|
|
REDUCTION OF ELBOW(T
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
761T0551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REDUCTION OF ELBOW(T
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
761T0551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REDUCTION OF RECTAL PROLAPSE
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 45900
|
| Hospital Charge Code |
76102775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.53 |
| Max. Negotiated Rate |
$280.02 |
| Rate for Payer: Aetna Commercial |
$280.02
|
| Rate for Payer: Ambetter Exchange |
$202.26
|
| Rate for Payer: Anthem Medicaid |
$67.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.71
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$259.52
|
| Rate for Payer: Healthspan PPO |
$236.14
|
| Rate for Payer: Humana Medicaid |
$67.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.88
|
| Rate for Payer: Molina Healthcare Passport |
$67.53
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.94
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.26
|
|
|
REDUCT OF OVERCORRECTOF PTOSIS
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 67909
|
| Hospital Charge Code |
76102396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
REDUCT OF OVERCORRECTOF PTOSIS
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 67909
|
| Hospital Charge Code |
761P2396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna Commercial |
$577.61
|
| Rate for Payer: Ambetter Exchange |
$402.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$244.05
|
| Rate for Payer: Anthem Medicaid |
$344.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.43
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$728.18
|
| Rate for Payer: Healthspan PPO |
$619.66
|
| Rate for Payer: Humana Medicaid |
$344.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$554.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.16
|
| Rate for Payer: Molina Healthcare Passport |
$344.27
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.72
|
| Rate for Payer: UHCCP Medicaid |
$256.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.86
|
|
|
REDUCT OF OVERCORRECTOF PTOSIS
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 67909
|
| Hospital Charge Code |
76102396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.37 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
REDUCT OF OVERCORRECTOF PTOSIS
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 67909
|
| Hospital Charge Code |
76102396
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.05 |
| Max. Negotiated Rate |
$1,119.00 |
| Rate for Payer: Aetna Commercial |
$577.61
|
| Rate for Payer: Ambetter Exchange |
$402.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$244.05
|
| Rate for Payer: Anthem Medicaid |
$344.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.43
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$728.18
|
| Rate for Payer: Healthspan PPO |
$619.66
|
| Rate for Payer: Humana Medicaid |
$344.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$554.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$351.16
|
| Rate for Payer: Molina Healthcare Passport |
$344.27
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.72
|
| Rate for Payer: UHCCP Medicaid |
$256.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.86
|
|
|
REF ALL POLY 22ID 40OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 40OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 43OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 43OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 46OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 46OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 49OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 49OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 52OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 52OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
