|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$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 Medicaid |
$756.58
|
| 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: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| 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: Molina Healthcare Medicaid |
$771.76
|
| 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
|
|
|
REMOVAL OF SMALL INTESTINE(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
761P1812
|
|
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 SPERM DUCT(S)
|
Facility
|
OP
|
$4,173.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.49 |
| Max. Negotiated Rate |
$4,006.08 |
| Rate for Payer: Aetna Commercial |
$3,213.21
|
| Rate for Payer: Anthem Medicaid |
$1,435.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,086.50
|
| Rate for Payer: Cash Price |
$2,086.50
|
| Rate for Payer: Cigna Commercial |
$3,463.59
|
| Rate for Payer: First Health Commercial |
$3,964.35
|
| Rate for Payer: Humana Commercial |
$3,547.05
|
| Rate for Payer: Humana KY Medicaid |
$1,435.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,449.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,463.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,672.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.63
|
| Rate for Payer: PHCS Commercial |
$4,006.08
|
| Rate for Payer: United Healthcare All Payer |
$3,672.24
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$4,173.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.49 |
| Max. Negotiated Rate |
$4,006.08 |
| Rate for Payer: Aetna Commercial |
$3,213.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.94
|
| Rate for Payer: Cash Price |
$2,086.50
|
| Rate for Payer: Cigna Commercial |
$3,463.59
|
| Rate for Payer: First Health Commercial |
$3,964.35
|
| Rate for Payer: Humana Commercial |
$3,547.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,672.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$834.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$542.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.63
|
| Rate for Payer: PHCS Commercial |
$4,006.08
|
| Rate for Payer: United Healthcare All Payer |
$3,672.24
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$4,173.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$4,173.00 |
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.42
|
| Rate for Payer: Anthem Medicaid |
$136.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,086.50
|
| Rate for Payer: Cash Price |
$2,086.50
|
| Rate for Payer: Cigna Commercial |
$771.35
|
| Rate for Payer: Healthspan PPO |
$653.67
|
| Rate for Payer: Humana Medicaid |
$136.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.00
|
| Rate for Payer: Molina Healthcare Passport |
$136.27
|
| Rate for Payer: Multiplan PHCS |
$2,503.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,921.10
|
| Rate for Payer: UHCCP Medicaid |
$170.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.63
|
|
|
REMOVAL OF SPERM DUCT(S)(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761P2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$771.35 |
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.42
|
| Rate for Payer: Anthem Medicaid |
$136.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$771.35
|
| Rate for Payer: Healthspan PPO |
$653.67
|
| Rate for Payer: Humana Medicaid |
$136.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.00
|
| Rate for Payer: Molina Healthcare Passport |
$136.27
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$170.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.63
|
|
|
REMOVAL OF SPERM DUCT(S)(T
|
Facility
|
IP
|
$3,623.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761T2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.99 |
| Max. Negotiated Rate |
$3,478.08 |
| Rate for Payer: Aetna Commercial |
$2,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,825.94
|
| Rate for Payer: Cash Price |
$1,811.50
|
| Rate for Payer: Cigna Commercial |
$3,007.09
|
| Rate for Payer: First Health Commercial |
$3,441.85
|
| Rate for Payer: Humana Commercial |
$3,079.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,970.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,673.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,086.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,188.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,717.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.13
|
| Rate for Payer: PHCS Commercial |
$3,478.08
|
| Rate for Payer: United Healthcare All Payer |
$3,188.24
|
|
|
REMOVAL OF SPERM DUCT(S)(T
|
Facility
|
OP
|
$3,623.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761T2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.99 |
| Max. Negotiated Rate |
$3,478.08 |
| Rate for Payer: Aetna Commercial |
$2,789.71
|
| Rate for Payer: Anthem Medicaid |
$1,245.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,825.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,811.50
|
| Rate for Payer: Cash Price |
$1,811.50
|
| Rate for Payer: Cigna Commercial |
$3,007.09
|
| Rate for Payer: First Health Commercial |
$3,441.85
|
| Rate for Payer: Humana Commercial |
$3,079.55
|
| Rate for Payer: Humana KY Medicaid |
$1,245.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,258.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,970.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,673.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,270.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,188.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,717.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,123.13
|
| Rate for Payer: PHCS Commercial |
$3,478.08
|
| Rate for Payer: United Healthcare All Payer |
$3,188.24
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,644.06 |
| Rate for Payer: Aetna Commercial |
$1,644.06
|
| Rate for Payer: Anthem Medicaid |
$593.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.51
|
| Rate for Payer: Healthspan PPO |
$1,314.57
|
| Rate for Payer: Humana Medicaid |
$593.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,478.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$605.48
|
| Rate for Payer: Molina Healthcare Passport |
$593.61
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$599.55
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVAL OF SPLEEN PARTIAL(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
761P1586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,644.06 |
| Rate for Payer: Aetna Commercial |
$1,644.06
|
| Rate for Payer: Anthem Medicaid |
$593.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.51
|
| Rate for Payer: Healthspan PPO |
$1,314.57
|
| Rate for Payer: Humana Medicaid |
$593.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,478.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$605.48
|
| Rate for Payer: Molina Healthcare Passport |
$593.61
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$599.55
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Anthem Medicaid |
$95.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$160.92
|
| Rate for Payer: Healthspan PPO |
$143.13
|
| Rate for Payer: Humana Medicaid |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.64
|
| Rate for Payer: Molina Healthcare Passport |
$95.73
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.69
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 43633
|
| Hospital Charge Code |
76102643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.25 |
| Max. Negotiated Rate |
$2,702.63 |
| Rate for Payer: Aetna Commercial |
$2,702.63
|
| Rate for Payer: Anthem Medicaid |
$941.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,195.00
|
| Rate for Payer: Cash Price |
$1,097.50
|
| Rate for Payer: Cash Price |
$1,097.50
|
| Rate for Payer: Cigna Commercial |
$2,461.75
|
| Rate for Payer: Healthspan PPO |
$2,279.18
|
| Rate for Payer: Humana Medicaid |
$941.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,448.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$960.63
|
| Rate for Payer: Molina Healthcare Passport |
$941.79
|
| Rate for Payer: Multiplan PHCS |
$1,317.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,536.50
|
| Rate for Payer: UHCCP Medicaid |
$768.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$951.21
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.65
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
REMOVAL OF STOMACH PARTIAL(P
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
761P1786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Anthem Medicaid |
$95.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$160.92
|
| Rate for Payer: Healthspan PPO |
$143.13
|
| Rate for Payer: Humana Medicaid |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.64
|
| Rate for Payer: Molina Healthcare Passport |
$95.73
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.69
|
|
|
REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS, OPEN
|
Facility
|
OP
|
$3,440.07
|
|
|
Service Code
|
CPT 23000
|
|
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 SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 0573T
|
|
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 SUBSTERNAL IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 0580T
|
|
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 SUPPORT IMPLANT
|
Professional
|
Both
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.08 |
| Max. Negotiated Rate |
$7,401.00 |
| Rate for Payer: Aetna Commercial |
$596.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.39
|
| Rate for Payer: Anthem Medicaid |
$197.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,401.00
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$628.39
|
| Rate for Payer: Healthspan PPO |
$745.55
|
| Rate for Payer: Humana Medicaid |
$197.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.02
|
| Rate for Payer: Molina Healthcare Passport |
$197.08
|
| Rate for Payer: Multiplan PHCS |
$4,440.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,180.70
|
| Rate for Payer: UHCCP Medicaid |
$225.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.05
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Facility
|
OP
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.13 |
| Max. Negotiated Rate |
$7,104.96 |
| Rate for Payer: Aetna Commercial |
$5,698.77
|
| Rate for Payer: Anthem Medicaid |
$2,545.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$6,142.83
|
| Rate for Payer: First Health Commercial |
$7,030.95
|
| Rate for Payer: Humana Commercial |
$6,290.85
|
| Rate for Payer: Humana KY Medicaid |
$2,545.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,571.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,596.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,294.31
|
| Rate for Payer: PHCS Commercial |
$7,104.96
|
| Rate for Payer: United Healthcare All Payer |
$6,512.88
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Facility
|
IP
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.13 |
| Max. Negotiated Rate |
$7,104.96 |
| Rate for Payer: Aetna Commercial |
$5,698.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.78
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$6,142.83
|
| Rate for Payer: First Health Commercial |
$7,030.95
|
| Rate for Payer: Humana Commercial |
$6,290.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,220.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$962.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,294.31
|
| Rate for Payer: PHCS Commercial |
$7,104.96
|
| Rate for Payer: United Healthcare All Payer |
$6,512.88
|
|
|
REMOVAL OF SUPPORT IMPLANT(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
761P0350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.08 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$596.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.39
|
| Rate for Payer: Anthem Medicaid |
$197.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$628.39
|
| Rate for Payer: Healthspan PPO |
$745.55
|
| Rate for Payer: Humana Medicaid |
$197.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.02
|
| Rate for Payer: Molina Healthcare Passport |
$197.08
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$225.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.05
|
|
|
REMOVAL OF SUPPORT IMPLANT(T
|
Facility
|
OP
|
$6,501.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
761T0350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$845.13 |
| Max. Negotiated Rate |
$6,240.96 |
| Rate for Payer: Aetna Commercial |
$5,005.77
|
| Rate for Payer: Anthem Medicaid |
$2,235.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,070.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,250.50
|
| Rate for Payer: Cash Price |
$3,250.50
|
| Rate for Payer: Cigna Commercial |
$5,395.83
|
| Rate for Payer: First Health Commercial |
$6,175.95
|
| Rate for Payer: Humana Commercial |
$5,525.85
|
| Rate for Payer: Humana KY Medicaid |
$2,235.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,258.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,330.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,797.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,280.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,720.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,875.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,300.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,015.31
|
| Rate for Payer: PHCS Commercial |
$6,240.96
|
| Rate for Payer: United Healthcare All Payer |
$5,720.88
|
|
