|
REMOVAL OF NECK WRINKLES(T
|
Facility
|
OP
|
$6,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
761T0218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.43 |
| Max. Negotiated Rate |
$5,955.21 |
| Rate for Payer: Aetna Commercial |
$4,776.57
|
| Rate for Payer: Anthem Medicaid |
$2,133.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,838.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cigna Commercial |
$5,148.77
|
| Rate for Payer: First Health Commercial |
$5,893.17
|
| Rate for Payer: Humana Commercial |
$5,272.84
|
| Rate for Payer: Humana KY Medicaid |
$2,133.33
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,155.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,086.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,578.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,176.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,458.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.04
|
| Rate for Payer: PHCS Commercial |
$5,955.21
|
| Rate for Payer: United Healthcare All Payer |
$5,458.94
|
|
|
REMOVAL OF NECK WRINKLES(T
|
Facility
|
IP
|
$6,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
761T0218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.43 |
| Max. Negotiated Rate |
$5,955.21 |
| Rate for Payer: Aetna Commercial |
$4,776.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,838.61
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cigna Commercial |
$5,148.77
|
| Rate for Payer: First Health Commercial |
$5,893.17
|
| Rate for Payer: Humana Commercial |
$5,272.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,086.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,578.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,861.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,458.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,923.04
|
| Rate for Payer: PHCS Commercial |
$5,955.21
|
| Rate for Payer: United Healthcare All Payer |
$5,458.94
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVAL OF NERVE LESION
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.01 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,703.41
|
| Rate for Payer: Anthem Medicaid |
$704.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,575.00
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,520.66
|
| Rate for Payer: Healthspan PPO |
$1,329.98
|
| Rate for Payer: Humana Medicaid |
$704.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.09
|
| Rate for Payer: Molina Healthcare Passport |
$704.01
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,802.50
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.05
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$8,064.71 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem Medicaid |
$885.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,760.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,064.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,776.69
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Humana Medicare Advantage |
$5,760.51
|
| Rate for Payer: Kentucky WC Medicaid |
$894.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,912.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$903.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVAL OF NERVE LESION(P
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
761P2370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.01 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,703.41
|
| Rate for Payer: Anthem Medicaid |
$704.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,575.00
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,520.66
|
| Rate for Payer: Healthspan PPO |
$1,329.98
|
| Rate for Payer: Humana Medicaid |
$704.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.09
|
| Rate for Payer: Molina Healthcare Passport |
$704.01
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,802.50
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.05
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.70 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,086.41
|
| Rate for Payer: Anthem Medicaid |
$422.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,055.58
|
| Rate for Payer: Healthspan PPO |
$1,051.92
|
| Rate for Payer: Humana Medicaid |
$422.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.15
|
| Rate for Payer: Molina Healthcare Passport |
$422.70
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.93
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REMOVAL OF OVARY/TUBE(S)(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
761P2256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.70 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,086.41
|
| Rate for Payer: Anthem Medicaid |
$422.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,055.58
|
| Rate for Payer: Healthspan PPO |
$1,051.92
|
| Rate for Payer: Humana Medicaid |
$422.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.15
|
| Rate for Payer: Molina Healthcare Passport |
$422.70
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.93
|
|
|
REMOVAL OF PACEMAKER
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
REMOVAL OF PACEMAKER
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
REMOVAL OF PACEMAKER
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$411.29
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| 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 |
$403.27
|
| Rate for Payer: Healthspan PPO |
$404.38
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
|
|
REMOVAL OF PACEMAKER(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
761P1263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$411.29
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| 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 |
$403.27
|
| Rate for Payer: Healthspan PPO |
$404.38
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.36 |
| Max. Negotiated Rate |
$2,033.00 |
| Rate for Payer: Aetna Commercial |
$841.25
|
| Rate for Payer: Anthem Medicaid |
$391.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$792.05
|
| Rate for Payer: Healthspan PPO |
$827.12
|
| Rate for Payer: Humana Medicaid |
$391.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.19
|
| Rate for Payer: Molina Healthcare Passport |
$391.36
|
| Rate for Payer: Multiplan PHCS |
$1,219.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,423.10
|
| Rate for Payer: UHCCP Medicaid |
$711.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.27
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Facility
|
OP
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.29 |
| Max. Negotiated Rate |
$4,754.25 |
| Rate for Payer: Aetna Commercial |
$1,565.41
|
| Rate for Payer: Anthem Medicaid |
$699.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,754.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,584.45
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$1,687.39
|
| Rate for Payer: First Health Commercial |
$1,931.35
|
| Rate for Payer: Humana Commercial |
$1,728.05
|
| Rate for Payer: Humana KY Medicaid |
$699.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Kentucky WC Medicaid |
$706.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.23
|
| Rate for Payer: PHCS Commercial |
$1,951.68
|
| Rate for Payer: United Healthcare All Payer |
$1,789.04
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Facility
|
IP
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.29 |
| Max. Negotiated Rate |
$1,951.68 |
| Rate for Payer: Aetna Commercial |
$1,565.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.74
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$1,687.39
|
| Rate for Payer: First Health Commercial |
$1,931.35
|
| Rate for Payer: Humana Commercial |
$1,728.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.23
|
| Rate for Payer: PHCS Commercial |
$1,951.68
|
| Rate for Payer: United Healthcare All Payer |
$1,789.04
|
|
|
REMOVAL OF PACEMAKER SYSTEM(P
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
761P1264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.36 |
| Max. Negotiated Rate |
$2,033.00 |
| Rate for Payer: Aetna Commercial |
$841.25
|
| Rate for Payer: Anthem Medicaid |
$391.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,033.00
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$792.05
|
| Rate for Payer: Healthspan PPO |
$827.12
|
| Rate for Payer: Humana Medicaid |
$391.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.19
|
| Rate for Payer: Molina Healthcare Passport |
$391.36
|
| Rate for Payer: Multiplan PHCS |
$1,219.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,423.10
|
| Rate for Payer: UHCCP Medicaid |
$711.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.27
|
|
|
REMOVAL OF PALM TENDON EACH
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$633.68 |
| Rate for Payer: Aetna Commercial |
$571.43
|
| Rate for Payer: Anthem Medicaid |
$222.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$605.00
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$633.68
|
| Rate for Payer: Healthspan PPO |
$517.59
|
| Rate for Payer: Humana Medicaid |
$222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$494.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.86
|
| Rate for Payer: Molina Healthcare Passport |
$222.41
|
| Rate for Payer: Multiplan PHCS |
$363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.50
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.63
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem Medicaid |
$208.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Humana KY Medicaid |
$208.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$210.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.55
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.65 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.55
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
REMOVAL OF PALM TENDON EACH(P
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
761P0679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$633.68 |
| Rate for Payer: Aetna Commercial |
$571.43
|
| Rate for Payer: Anthem Medicaid |
$222.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$605.00
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$633.68
|
| Rate for Payer: Healthspan PPO |
$517.59
|
| Rate for Payer: Humana Medicaid |
$222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$494.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.86
|
| Rate for Payer: Molina Healthcare Passport |
$222.41
|
| Rate for Payer: Multiplan PHCS |
$363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.50
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.63
|
|
|
REMOVAL OF PERITONEAL SHUNT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
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 PERITONEAL SHUNT
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.09 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$673.78
|
| Rate for Payer: Anthem Medicaid |
$294.09
|
| 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 |
$633.53
|
| Rate for Payer: Healthspan PPO |
$568.22
|
| Rate for Payer: Humana Medicaid |
$294.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.97
|
| Rate for Payer: Molina Healthcare Passport |
$294.09
|
| 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 |
$297.03
|
|
|
REMOVAL OF PERITONEAL SHUNT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$650.00
|
| 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: Humana Medicare Advantage |
$2,756.39
|
| 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 |
$3,307.67
|
| 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
|
|
