|
REMOVAL OF IMPLANT(T
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
761T0349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$613.08 |
| Max. Negotiated Rate |
$4,527.36 |
| Rate for Payer: Aetna Commercial |
$3,631.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.48
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Cigna Commercial |
$3,914.28
|
| Rate for Payer: First Health Commercial |
$4,480.20
|
| Rate for Payer: Humana Commercial |
$4,008.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,867.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,150.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,537.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,461.96
|
| Rate for Payer: PHCS Commercial |
$4,527.36
|
| Rate for Payer: United Healthcare All Payer |
$4,150.08
|
|
|
REMOVAL OF IMPLANT(T
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
761T0349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$613.08 |
| Max. Negotiated Rate |
$4,527.36 |
| Rate for Payer: Aetna Commercial |
$3,631.32
|
| Rate for Payer: Anthem Medicaid |
$1,621.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,678.48
|
| 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 |
$2,358.00
|
| Rate for Payer: Cash Price |
$2,358.00
|
| Rate for Payer: Cigna Commercial |
$3,914.28
|
| Rate for Payer: First Health Commercial |
$4,480.20
|
| Rate for Payer: Humana Commercial |
$4,008.60
|
| Rate for Payer: Humana KY Medicaid |
$1,621.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,638.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,867.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,480.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,654.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,150.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,537.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,461.96
|
| Rate for Payer: PHCS Commercial |
$4,527.36
|
| Rate for Payer: United Healthcare All Payer |
$4,150.08
|
|
|
REMOVAL OF IMP W/CAPSULECTOMY
|
Professional
|
Both
|
$1,250.00
|
|
| Hospital Charge Code |
22200047
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
|
|
REMOVAL OF INTACT BREAST IMPLANT
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$388.39
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.42 |
| Max. Negotiated Rate |
$388.39 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
|
|
REMOVAL OF KIDNEY & URETER
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 50234
|
| Hospital Charge Code |
76102821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$2,124.01 |
| Rate for Payer: Aetna Commercial |
$2,124.01
|
| Rate for Payer: Anthem Medicaid |
$1,106.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,894.90
|
| Rate for Payer: Healthspan PPO |
$1,698.34
|
| Rate for Payer: Humana Medicaid |
$1,106.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,776.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,128.24
|
| Rate for Payer: Molina Healthcare Passport |
$1,106.12
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,117.18
|
|
|
REMOVAL OF KIDNEY & URETER
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 50234
|
| Hospital Charge Code |
76102821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REMOVAL OF KIDNEY & URETER
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 50234
|
| Hospital Charge Code |
76102821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REMOVAL OF KNEECAP
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
76100823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem Medicaid |
$564.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| 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 |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Humana KY Medicaid |
$564.00
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$569.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
REMOVAL OF KNEECAP
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
76100823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.69 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$948.74
|
| Rate for Payer: Anthem Medicaid |
$509.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,039.87
|
| Rate for Payer: Healthspan PPO |
$859.36
|
| Rate for Payer: Humana Medicaid |
$509.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$804.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.88
|
| Rate for Payer: Molina Healthcare Passport |
$509.69
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.79
|
|
|
REMOVAL OF KNEECAP
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
76100823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
REMOVAL OF KNEECAP(P
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27350
|
| Hospital Charge Code |
761P0823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.69 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$948.74
|
| Rate for Payer: Anthem Medicaid |
$509.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,039.87
|
| Rate for Payer: Healthspan PPO |
$859.36
|
| Rate for Payer: Humana Medicaid |
$509.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$804.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.88
|
| Rate for Payer: Molina Healthcare Passport |
$509.69
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.79
|
|
|
REMOVAL OF KNEE CARTILAGE
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27332
|
| Hospital Charge Code |
76102726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$1,021.04 |
| Rate for Payer: Aetna Commercial |
$933.81
|
| Rate for Payer: Anthem Medicaid |
$541.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$845.00
|
| Rate for Payer: Cash Price |
$422.50
|
| Rate for Payer: Cash Price |
$422.50
|
| Rate for Payer: Cigna Commercial |
$1,021.04
|
| Rate for Payer: Healthspan PPO |
$845.83
|
| Rate for Payer: Humana Medicaid |
$541.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$789.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.78
|
| Rate for Payer: Molina Healthcare Passport |
$541.94
|
| Rate for Payer: Multiplan PHCS |
$507.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$591.50
|
| Rate for Payer: UHCCP Medicaid |
$295.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$547.36
|
|
|
REMOVAL OF KNEE PROSTHESIS
|
Facility
|
OP
|
$2,725.00
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
76100854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.25 |
| Max. Negotiated Rate |
$2,616.00 |
| Rate for Payer: Aetna Commercial |
$2,098.25
|
| Rate for Payer: Anthem Medicaid |
$937.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,125.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna Commercial |
$2,261.75
|
| Rate for Payer: First Health Commercial |
$2,588.75
|
| Rate for Payer: Humana Commercial |
$2,316.25
|
| Rate for Payer: Humana KY Medicaid |
$937.13
|
| Rate for Payer: Kentucky WC Medicaid |
$946.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,234.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,011.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$817.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$955.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,398.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,043.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$844.75
|
| Rate for Payer: PHCS Commercial |
$2,616.00
|
| Rate for Payer: United Healthcare All Payer |
$2,398.00
|
|
|
REMOVAL OF KNEE PROSTHESIS
|
Facility
|
IP
|
$2,725.00
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
76100854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.25 |
| Max. Negotiated Rate |
$2,616.00 |
| Rate for Payer: Aetna Commercial |
$2,098.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,125.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna Commercial |
$2,261.75
|
| Rate for Payer: First Health Commercial |
$2,588.75
|
| Rate for Payer: Humana Commercial |
$2,316.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,234.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,011.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$817.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,398.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,043.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$354.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$844.75
|
| Rate for Payer: PHCS Commercial |
$2,616.00
|
| Rate for Payer: United Healthcare All Payer |
$2,398.00
|
|
|
REMOVAL OF KNEE PROSTHESIS
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
76100854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.03 |
| Max. Negotiated Rate |
$2,725.00 |
| Rate for Payer: Aetna Commercial |
$1,785.75
|
| Rate for Payer: Anthem Medicaid |
$921.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,725.00
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna Commercial |
$1,929.43
|
| Rate for Payer: Healthspan PPO |
$1,617.50
|
| Rate for Payer: Humana Medicaid |
$921.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,504.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.45
|
| Rate for Payer: Molina Healthcare Passport |
$921.03
|
| Rate for Payer: Multiplan PHCS |
$1,635.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,907.50
|
| Rate for Payer: UHCCP Medicaid |
$953.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.24
|
|
|
REMOVAL OF KNEE PROSTHESIS(P
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 27488
|
| Hospital Charge Code |
761P0854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$921.03 |
| Max. Negotiated Rate |
$2,725.00 |
| Rate for Payer: Aetna Commercial |
$1,785.75
|
| Rate for Payer: Anthem Medicaid |
$921.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,725.00
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cash Price |
$1,362.50
|
| Rate for Payer: Cigna Commercial |
$1,929.43
|
| Rate for Payer: Healthspan PPO |
$1,617.50
|
| Rate for Payer: Humana Medicaid |
$921.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,504.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$939.45
|
| Rate for Payer: Molina Healthcare Passport |
$921.03
|
| Rate for Payer: Multiplan PHCS |
$1,635.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,907.50
|
| Rate for Payer: UHCCP Medicaid |
$953.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$930.24
|
|
|
REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION
|
Facility
|
OP
|
$2,821.27
|
|
|
Service Code
|
CPT 66850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,015.19 |
| Max. Negotiated Rate |
$2,821.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,015.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,821.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,720.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,015.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,418.23
|
|
|
REMOVAL OF LUNG
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 32484
|
| Hospital Charge Code |
76101191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REMOVAL OF LUNG
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 32440
|
| Hospital Charge Code |
76101188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
REMOVAL OF LUNG
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 32484
|
| Hospital Charge Code |
76101191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,111.27 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,417.70
|
| Rate for Payer: Anthem Medicaid |
$1,111.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,303.54
|
| Rate for Payer: Healthspan PPO |
$1,887.68
|
| Rate for Payer: Humana Medicaid |
$1,111.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,005.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,133.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,111.27
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,122.38
|
|
|
REMOVAL OF LUNG
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 32484
|
| Hospital Charge Code |
76101191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem Medicaid |
$1,203.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Humana KY Medicaid |
$1,203.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
REMOVAL OF LUNG
|
Professional
|
Both
|
$3,400.00
|
|
|
Service Code
|
HCPCS 32480
|
| Hospital Charge Code |
76101189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,110.19 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna Commercial |
$2,517.94
|
| Rate for Payer: Anthem Medicaid |
$1,110.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,400.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,396.37
|
| Rate for Payer: Healthspan PPO |
$1,965.94
|
| Rate for Payer: Humana Medicaid |
$1,110.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,067.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,132.39
|
| Rate for Payer: Molina Healthcare Passport |
$1,110.19
|
| Rate for Payer: Multiplan PHCS |
$2,040.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,380.00
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,121.29
|
|
|
REMOVAL OF LUNG
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 32480
|
| Hospital Charge Code |
76101189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Humana KY Medicaid |
$1,169.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
REMOVAL OF LUNG
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 32440
|
| Hospital Charge Code |
76101188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Humana KY Medicaid |
$1,169.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
