|
REMOVAL OF PERITONEAL SHUNT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
761P2004
|
|
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 PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Facility
|
OP
|
$10,285.34
|
|
|
Service Code
|
CPT 33233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,346.67 |
| Max. Negotiated Rate |
$10,285.34 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,346.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,285.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,918.00
|
| Rate for Payer: Humana Medicare Advantage |
$7,346.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,816.00
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; DUAL LEAD SYSTEM
|
Facility
|
OP
|
$12,927.70
|
|
|
Service Code
|
CPT 33228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,234.07 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; MULTIPLE LEAD SYSTEM
|
Facility
|
OP
|
$23,589.87
|
|
|
Service Code
|
CPT 33229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,849.91 |
| Max. Negotiated Rate |
$23,589.87 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,849.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,589.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,747.38
|
| Rate for Payer: Humana Medicare Advantage |
$16,849.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,219.89
|
|
|
REMOVAL OF RIB
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF RIB
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.30 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Anthem Medicaid |
$584.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,109.28
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$584.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.99
|
| Rate for Payer: Molina Healthcare Passport |
$584.30
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.14
|
|
|
REMOVAL OF RIB
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF RIB(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
761P0400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.30 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Anthem Medicaid |
$584.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,109.28
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$584.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.99
|
| Rate for Payer: Molina Healthcare Passport |
$584.30
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.14
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$372.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.07
|
| Rate for Payer: Anthem Medicaid |
$133.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$370.66
|
| Rate for Payer: Healthspan PPO |
$430.56
|
| Rate for Payer: Humana Medicaid |
$133.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$331.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.56
|
| Rate for Payer: Molina Healthcare Passport |
$133.88
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$175.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.22
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.10 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$492.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.81
|
| Rate for Payer: Anthem Medicaid |
$199.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$489.80
|
| Rate for Payer: Healthspan PPO |
$544.05
|
| Rate for Payer: Humana Medicaid |
$199.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.08
|
| Rate for Payer: Molina Healthcare Passport |
$199.10
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$261.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.09
|
|
|
REMOVAL OF SALIVARY STONE(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
761P1682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$372.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.07
|
| Rate for Payer: Anthem Medicaid |
$133.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$370.66
|
| Rate for Payer: Healthspan PPO |
$430.56
|
| Rate for Payer: Humana Medicaid |
$133.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$331.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.56
|
| Rate for Payer: Molina Healthcare Passport |
$133.88
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$175.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.22
|
|
|
REMOVAL OF SALIVARY STONE(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
761P1683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.10 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$492.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.81
|
| Rate for Payer: Anthem Medicaid |
$199.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$489.80
|
| Rate for Payer: Healthspan PPO |
$544.05
|
| Rate for Payer: Humana Medicaid |
$199.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.08
|
| Rate for Payer: Molina Healthcare Passport |
$199.10
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$261.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.09
|
|
|
REMOVAL OF SESAMOID BONE
|
Professional
|
Both
|
$5,855.00
|
|
|
Service Code
|
HCPCS 28315
|
| Hospital Charge Code |
76102659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$5,855.00 |
| Rate for Payer: Aetna Commercial |
$500.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.46
|
| Rate for Payer: Anthem Medicaid |
$258.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,855.00
|
| Rate for Payer: Cash Price |
$2,927.50
|
| Rate for Payer: Cash Price |
$2,927.50
|
| Rate for Payer: Cigna Commercial |
$542.32
|
| Rate for Payer: Healthspan PPO |
$591.63
|
| Rate for Payer: Humana Medicaid |
$258.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.84
|
| Rate for Payer: Molina Healthcare Passport |
$258.67
|
| Rate for Payer: Multiplan PHCS |
$3,513.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,098.50
|
| Rate for Payer: UHCCP Medicaid |
$174.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.26
|
|
|
REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR ELECTRODE(S); BY TRANSVENOUS EXTRACTION
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 33244
|
|
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 SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
REMOVAL OF SKULL LESION
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Anthem Medicaid |
$1,547.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,510.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$3,735.00
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Humana Commercial |
$3,825.00
|
| Rate for Payer: Humana KY Medicaid |
$1,547.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,690.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,321.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,960.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.00
|
| Rate for Payer: PHCS Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Payer |
$3,960.00
|
|
|
REMOVAL OF SKULL LESION
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,510.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$3,735.00
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Humana Commercial |
$3,825.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,690.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,321.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,960.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.00
|
| Rate for Payer: PHCS Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Payer |
$3,960.00
|
|
|
REMOVAL OF SKULL LESION
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.09 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$2,137.34
|
| Rate for Payer: Anthem Medicaid |
$1,122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,500.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$1,919.27
|
| Rate for Payer: Healthspan PPO |
$1,668.78
|
| Rate for Payer: Humana Medicaid |
$1,122.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,737.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.53
|
| Rate for Payer: Molina Healthcare Passport |
$1,122.09
|
| Rate for Payer: Multiplan PHCS |
$2,700.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,150.00
|
| Rate for Payer: UHCCP Medicaid |
$1,575.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.31
|
|
|
REMOVAL OF SKULL LESION(P
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
761P2285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.09 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$2,137.34
|
| Rate for Payer: Anthem Medicaid |
$1,122.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,500.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$1,919.27
|
| Rate for Payer: Healthspan PPO |
$1,668.78
|
| Rate for Payer: Humana Medicaid |
$1,122.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,737.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.53
|
| Rate for Payer: Molina Healthcare Passport |
$1,122.09
|
| Rate for Payer: Multiplan PHCS |
$2,700.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,150.00
|
| Rate for Payer: UHCCP Medicaid |
$1,575.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.31
|
|
|
REMOVAL OF SMALL INTESTINE
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
76101812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.61 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,705.00
|
| Rate for Payer: Anthem Medicaid |
$729.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,584.81
|
| Rate for Payer: Healthspan PPO |
$1,437.86
|
| Rate for Payer: Humana Medicaid |
$729.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,506.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.20
|
| Rate for Payer: Molina Healthcare Passport |
$729.61
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.91
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
76101812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
