|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$5,982.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.32 |
| Max. Negotiated Rate |
$5,982.00 |
| Rate for Payer: Aetna Commercial |
$364.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.32
|
| Rate for Payer: Anthem Medicaid |
$162.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,982.00
|
| Rate for Payer: Cash Price |
$2,991.00
|
| Rate for Payer: Cash Price |
$2,991.00
|
| Rate for Payer: Cigna Commercial |
$400.67
|
| Rate for Payer: Healthspan PPO |
$583.41
|
| Rate for Payer: Humana Medicaid |
$162.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.86
|
| Rate for Payer: Molina Healthcare Passport |
$162.61
|
| Rate for Payer: Multiplan PHCS |
$3,589.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,187.40
|
| Rate for Payer: UHCCP Medicaid |
$132.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.24
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$5,982.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.66 |
| Max. Negotiated Rate |
$5,742.72 |
| Rate for Payer: Aetna Commercial |
$4,606.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,665.96
|
| Rate for Payer: Cash Price |
$2,991.00
|
| Rate for Payer: Cigna Commercial |
$4,965.06
|
| Rate for Payer: First Health Commercial |
$5,682.90
|
| Rate for Payer: Humana Commercial |
$5,084.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,905.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,414.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,794.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,264.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,486.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,854.42
|
| Rate for Payer: PHCS Commercial |
$5,742.72
|
| Rate for Payer: United Healthcare All Payer |
$5,264.16
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$5,982.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.66 |
| Max. Negotiated Rate |
$5,742.72 |
| Rate for Payer: Aetna Commercial |
$4,606.14
|
| Rate for Payer: Anthem Medicaid |
$2,057.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,665.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,991.00
|
| Rate for Payer: Cash Price |
$2,991.00
|
| Rate for Payer: Cigna Commercial |
$4,965.06
|
| Rate for Payer: First Health Commercial |
$5,682.90
|
| Rate for Payer: Humana Commercial |
$5,084.70
|
| Rate for Payer: Humana KY Medicaid |
$2,057.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,078.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,905.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,414.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,098.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,264.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,486.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,854.42
|
| Rate for Payer: PHCS Commercial |
$5,742.72
|
| Rate for Payer: United Healthcare All Payer |
$5,264.16
|
|
|
REMOVAL OF FOREIGN BODY ARM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.95 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$523.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.95
|
| Rate for Payer: Anthem Medicaid |
$220.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$578.67
|
| Rate for Payer: Healthspan PPO |
$687.43
|
| Rate for Payer: Humana Medicaid |
$220.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.56
|
| Rate for Payer: Molina Healthcare Passport |
$220.16
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$198.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.36
|
|
|
REMOVAL OF FOREIGN BODY ARM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOREIGN BODY ARM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOREIGN BODY ARM(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
761P0515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.95 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$523.96
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.95
|
| Rate for Payer: Anthem Medicaid |
$220.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$578.67
|
| Rate for Payer: Healthspan PPO |
$687.43
|
| Rate for Payer: Humana Medicaid |
$220.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.56
|
| Rate for Payer: Molina Healthcare Passport |
$220.16
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$198.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.36
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
IP
|
$130.00
|
|
| Hospital Charge Code |
76102556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
OP
|
$130.00
|
|
| Hospital Charge Code |
76102556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.30
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
45000328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$46.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$46.77
|
| Rate for Payer: Kentucky WC Medicaid |
$47.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
45000328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$42.16
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 20525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,457.19 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
45000248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
45000248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.62 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.94
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
76101631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
76101631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.06
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
REMOVAL OF FOREIGN BODY(P
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761P0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.32 |
| Max. Negotiated Rate |
$745.00 |
| Rate for Payer: Aetna Commercial |
$364.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.32
|
| Rate for Payer: Anthem Medicaid |
$162.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.00
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$400.67
|
| Rate for Payer: Healthspan PPO |
$583.41
|
| Rate for Payer: Humana Medicaid |
$162.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.86
|
| Rate for Payer: Molina Healthcare Passport |
$162.61
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$521.50
|
| Rate for Payer: UHCCP Medicaid |
$132.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.24
|
|
|
REMOVAL OF FOREIGN BODY(T
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761T0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.81 |
| Max. Negotiated Rate |
$5,027.52 |
| Rate for Payer: Aetna Commercial |
$4,032.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,084.86
|
| Rate for Payer: Cash Price |
$2,618.50
|
| Rate for Payer: Cigna Commercial |
$4,346.71
|
| Rate for Payer: First Health Commercial |
$4,975.15
|
| Rate for Payer: Humana Commercial |
$4,451.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,294.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,864.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,571.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,608.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,927.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,047.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,623.47
|
| Rate for Payer: PHCS Commercial |
$5,027.52
|
| Rate for Payer: United Healthcare All Payer |
$4,608.56
|
|
|
REMOVAL OF FOREIGN BODY(T
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761T0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.81 |
| Max. Negotiated Rate |
$5,027.52 |
| Rate for Payer: Aetna Commercial |
$4,032.49
|
| Rate for Payer: Anthem Medicaid |
$1,801.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,084.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,618.50
|
| Rate for Payer: Cash Price |
$2,618.50
|
| Rate for Payer: Cigna Commercial |
$4,346.71
|
| Rate for Payer: First Health Commercial |
$4,975.15
|
| Rate for Payer: Humana Commercial |
$4,451.45
|
| Rate for Payer: Humana KY Medicaid |
$1,801.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,819.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,294.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,864.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,837.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,608.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,927.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,047.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$680.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,623.47
|
| Rate for Payer: PHCS Commercial |
$5,027.52
|
| Rate for Payer: United Healthcare All Payer |
$4,608.56
|
|
|
REMOVAL OF HEEL SPUR
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.15 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$555.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.15
|
| Rate for Payer: Anthem Medicaid |
$309.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,380.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$602.53
|
| Rate for Payer: Healthspan PPO |
$650.56
|
| Rate for Payer: Humana Medicaid |
$309.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$445.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.60
|
| Rate for Payer: Molina Healthcare Passport |
$309.41
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.00
|
| Rate for Payer: UHCCP Medicaid |
$194.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.50
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem Medicaid |
$474.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Humana KY Medicaid |
$474.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$479.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$427.80
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
REMOVAL OF HEEL SPUR(P
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
761P0985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.15 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$555.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.15
|
| Rate for Payer: Anthem Medicaid |
$309.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,380.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$602.53
|
| Rate for Payer: Healthspan PPO |
$650.56
|
| Rate for Payer: Humana Medicaid |
$309.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$445.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.60
|
| Rate for Payer: Molina Healthcare Passport |
$309.41
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$966.00
|
| Rate for Payer: UHCCP Medicaid |
$194.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.50
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,209.08 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$2,398.22
|
| Rate for Payer: Anthem Medicaid |
$1,209.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$2,554.62
|
| Rate for Payer: Healthspan PPO |
$2,172.27
|
| Rate for Payer: Humana Medicaid |
$1,209.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,008.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,233.26
|
| Rate for Payer: Molina Healthcare Passport |
$1,209.08
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,221.17
|
|
