|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.41 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,232.74
|
| Rate for Payer: Anthem Medicaid |
$631.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,346.45
|
| Rate for Payer: Healthspan PPO |
$1,116.60
|
| Rate for Payer: Humana Medicaid |
$631.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.04
|
| Rate for Payer: Molina Healthcare Passport |
$631.41
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.72
|
|
|
REMOVAL OF HIP PROSTHESIS(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
761P0774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.41 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$1,232.74
|
| Rate for Payer: Anthem Medicaid |
$631.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,346.45
|
| Rate for Payer: Healthspan PPO |
$1,116.60
|
| Rate for Payer: Humana Medicaid |
$631.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.04
|
| Rate for Payer: Molina Healthcare Passport |
$631.41
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.72
|
|
|
REMOVAL OF HIP PROSTHESIS(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
761P0775
|
|
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
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REMOVAL OF HUMERUS LESION
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,081.72 |
| Rate for Payer: Aetna Commercial |
$985.40
|
| Rate for Payer: Anthem Medicaid |
$470.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$1,081.72
|
| Rate for Payer: Healthspan PPO |
$892.56
|
| Rate for Payer: Humana Medicaid |
$470.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.44
|
| Rate for Payer: Molina Healthcare Passport |
$470.04
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.74
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.25
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REMOVAL OF HUMERUS LESION(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
761P0449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,081.72 |
| Rate for Payer: Aetna Commercial |
$985.40
|
| Rate for Payer: Anthem Medicaid |
$470.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$1,081.72
|
| Rate for Payer: Healthspan PPO |
$892.56
|
| Rate for Payer: Humana Medicaid |
$470.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.44
|
| Rate for Payer: Molina Healthcare Passport |
$470.04
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.74
|
|
|
REMOVAL OF IMPACTED CERUMEN
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
76102535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
REMOVAL OF IMPACTED CERUMEN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
76102535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 57415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
REMOVAL OF IMPLANT
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,609.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.46
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
REMOVAL OF IMPLANT
|
Professional
|
Both
|
$5,366.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.19 |
| Max. Negotiated Rate |
$5,366.00 |
| Rate for Payer: Aetna Commercial |
$216.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.53
|
| Rate for Payer: Anthem Medicaid |
$62.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,366.00
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: Healthspan PPO |
$485.32
|
| Rate for Payer: Humana Medicaid |
$62.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.43
|
| Rate for Payer: Molina Healthcare Passport |
$62.19
|
| Rate for Payer: Multiplan PHCS |
$3,219.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,756.20
|
| Rate for Payer: UHCCP Medicaid |
$81.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.81
|
|
|
REMOVAL OF IMPLANT
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem Medicaid |
$1,845.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Humana KY Medicaid |
$1,845.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,864.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,882.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.46
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 33241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,395.89 |
| Max. Negotiated Rate |
$4,754.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,754.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,584.45
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
|
|
REMOVAL OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR WITH REPLACEMENT OF IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR; DUAL LEAD SYSTEM
|
Facility
|
OP
|
$28,536.86
|
|
|
Service Code
|
CPT 33263
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$20,383.47 |
| Max. Negotiated Rate |
$28,536.86 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,383.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28,536.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$27,517.68
|
| Rate for Payer: Humana Medicare Advantage |
$20,383.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,460.16
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 20680
|
|
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 IMPLANT FROM FINGER OR HAND
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 26320
|
|
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 IMPLANT(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
761P0349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.19 |
| Max. Negotiated Rate |
$766.70 |
| Rate for Payer: Aetna Commercial |
$216.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.53
|
| Rate for Payer: Anthem Medicaid |
$62.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$766.70
|
| Rate for Payer: Healthspan PPO |
$485.32
|
| Rate for Payer: Humana Medicaid |
$62.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.43
|
| Rate for Payer: Molina Healthcare Passport |
$62.19
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$81.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.81
|
|
|
REMOVAL OF IMPLANT SUPERF
|
Facility
|
IP
|
$1,423.00
|
|
| Hospital Charge Code |
36000175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.99 |
| Max. Negotiated Rate |
$1,366.08 |
| Rate for Payer: Aetna Commercial |
$1,095.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,109.94
|
| Rate for Payer: Cash Price |
$711.50
|
| Rate for Payer: Cigna Commercial |
$1,181.09
|
| Rate for Payer: First Health Commercial |
$1,351.85
|
| Rate for Payer: Humana Commercial |
$1,209.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,166.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,252.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,067.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.13
|
| Rate for Payer: PHCS Commercial |
$1,366.08
|
| Rate for Payer: United Healthcare All Payer |
$1,252.24
|
|
|
REMOVAL OF IMPLANT SUPERF
|
Facility
|
OP
|
$1,423.00
|
|
| Hospital Charge Code |
36000175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.99 |
| Max. Negotiated Rate |
$1,366.08 |
| Rate for Payer: Aetna Commercial |
$1,095.71
|
| Rate for Payer: Anthem Medicaid |
$489.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,109.94
|
| Rate for Payer: Cash Price |
$711.50
|
| Rate for Payer: Cigna Commercial |
$1,181.09
|
| Rate for Payer: First Health Commercial |
$1,351.85
|
| Rate for Payer: Humana Commercial |
$1,209.55
|
| Rate for Payer: Humana KY Medicaid |
$489.37
|
| Rate for Payer: Kentucky WC Medicaid |
$494.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,166.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,252.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,067.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.13
|
| Rate for Payer: PHCS Commercial |
$1,366.08
|
| Rate for Payer: United Healthcare All Payer |
$1,252.24
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 20670
|
|
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
|
|
