|
REMOVAL OF TRANS PACEMAKER
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
76101265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$4,754.25 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$1,050.00
|
| 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: Humana Medicare Advantage |
$3,395.89
|
| 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 |
$4,075.07
|
| 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 TRANS PACEMAKER(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
761P1265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.49 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,086.94
|
| Rate for Payer: Anthem Medicaid |
$444.49
|
| 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 |
$1,035.20
|
| Rate for Payer: Healthspan PPO |
$1,068.67
|
| Rate for Payer: Humana Medicaid |
$444.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.38
|
| Rate for Payer: Molina Healthcare Passport |
$444.49
|
| 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 |
$448.93
|
|
|
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); SINGLE LEAD SYSTEM, ATRIAL OR VENTRICULAR
|
Facility
|
OP
|
$4,754.25
|
|
|
Service Code
|
CPT 33234
|
|
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 TUNNELED CENTRAL VE
|
Professional
|
Both
|
$3,934.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$3,934.00 |
| Rate for Payer: Aetna Commercial |
$312.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.06
|
| Rate for Payer: Anthem Medicaid |
$152.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,934.00
|
| Rate for Payer: Cash Price |
$1,967.00
|
| Rate for Payer: Cash Price |
$1,967.00
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: Healthspan PPO |
$331.49
|
| Rate for Payer: Humana Medicaid |
$152.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.75
|
| Rate for Payer: Molina Healthcare Passport |
$152.70
|
| Rate for Payer: Multiplan PHCS |
$2,360.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,753.80
|
| Rate for Payer: UHCCP Medicaid |
$115.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.23
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761P1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$545.00 |
| Rate for Payer: Aetna Commercial |
$312.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.06
|
| Rate for Payer: Anthem Medicaid |
$152.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.00
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: Healthspan PPO |
$331.49
|
| Rate for Payer: Humana Medicaid |
$152.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.75
|
| Rate for Payer: Molina Healthcare Passport |
$152.70
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.50
|
| Rate for Payer: UHCCP Medicaid |
$115.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.23
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761T1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.57 |
| Max. Negotiated Rate |
$3,253.44 |
| Rate for Payer: Aetna Commercial |
$2,609.53
|
| Rate for Payer: Anthem Medicaid |
$1,165.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,643.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,694.50
|
| Rate for Payer: Cash Price |
$1,694.50
|
| Rate for Payer: Cigna Commercial |
$2,812.87
|
| Rate for Payer: First Health Commercial |
$3,219.55
|
| Rate for Payer: Humana Commercial |
$2,880.65
|
| Rate for Payer: Humana KY Medicaid |
$1,165.48
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,778.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,188.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,982.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,541.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.59
|
| Rate for Payer: PHCS Commercial |
$3,253.44
|
| Rate for Payer: United Healthcare All Payer |
$2,982.32
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
OP
|
$3,934.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.42 |
| Max. Negotiated Rate |
$3,776.64 |
| Rate for Payer: Aetna Commercial |
$3,029.18
|
| Rate for Payer: Anthem Medicaid |
$1,352.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,068.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$1,967.00
|
| Rate for Payer: Cash Price |
$1,967.00
|
| Rate for Payer: Cigna Commercial |
$3,265.22
|
| Rate for Payer: First Health Commercial |
$3,737.30
|
| Rate for Payer: Humana Commercial |
$3,343.90
|
| Rate for Payer: Humana KY Medicaid |
$1,352.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,903.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,461.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,950.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.54
|
| Rate for Payer: PHCS Commercial |
$3,776.64
|
| Rate for Payer: United Healthcare All Payer |
$3,461.92
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
IP
|
$3,934.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.42 |
| Max. Negotiated Rate |
$3,776.64 |
| Rate for Payer: Aetna Commercial |
$3,029.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,068.52
|
| Rate for Payer: Cash Price |
$1,967.00
|
| Rate for Payer: Cigna Commercial |
$3,265.22
|
| Rate for Payer: First Health Commercial |
$3,737.30
|
| Rate for Payer: Humana Commercial |
$3,343.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,225.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,903.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,461.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,950.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.54
|
| Rate for Payer: PHCS Commercial |
$3,776.64
|
| Rate for Payer: United Healthcare All Payer |
$3,461.92
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761T1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.57 |
| Max. Negotiated Rate |
$3,253.44 |
| Rate for Payer: Aetna Commercial |
$2,609.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,643.42
|
| Rate for Payer: Cash Price |
$1,694.50
|
| Rate for Payer: Cigna Commercial |
$2,812.87
|
| Rate for Payer: First Health Commercial |
$3,219.55
|
| Rate for Payer: Humana Commercial |
$2,880.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,778.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,982.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,541.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.59
|
| Rate for Payer: PHCS Commercial |
$3,253.44
|
| Rate for Payer: United Healthcare All Payer |
$2,982.32
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$1,938.90
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,384.93 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$760.54
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.24 |
| Max. Negotiated Rate |
$760.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
REMOVAL OF URETHRA LESION
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$974.19
|
| Rate for Payer: Anthem Medicaid |
$497.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,488.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$873.76
|
| Rate for Payer: Healthspan PPO |
$778.96
|
| Rate for Payer: Humana Medicaid |
$497.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$828.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.10
|
| Rate for Payer: Molina Healthcare Passport |
$497.16
|
| Rate for Payer: Multiplan PHCS |
$892.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,041.60
|
| Rate for Payer: UHCCP Medicaid |
$520.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.13
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$1,145.76
|
| Rate for Payer: Anthem Medicaid |
$511.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,235.04
|
| Rate for Payer: First Health Commercial |
$1,413.60
|
| Rate for Payer: Humana Commercial |
$1,264.80
|
| Rate for Payer: Humana KY Medicaid |
$511.72
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$516.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$521.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.28
|
| Rate for Payer: PHCS Commercial |
$1,428.48
|
| Rate for Payer: United Healthcare All Payer |
$1,309.44
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.44 |
| Max. Negotiated Rate |
$1,428.48 |
| Rate for Payer: Aetna Commercial |
$1,145.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.64
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,235.04
|
| Rate for Payer: First Health Commercial |
$1,413.60
|
| Rate for Payer: Humana Commercial |
$1,264.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.28
|
| Rate for Payer: PHCS Commercial |
$1,428.48
|
| Rate for Payer: United Healthcare All Payer |
$1,309.44
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
|
Facility
|
OP
|
$2,821.27
|
|
|
Service Code
|
CPT 67005
|
|
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 WRIST PROSTHESIS
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| 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 |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.28 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$755.55
|
| Rate for Payer: Anthem Medicaid |
$358.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$833.51
|
| Rate for Payer: Healthspan PPO |
$684.37
|
| Rate for Payer: Humana Medicaid |
$358.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.45
|
| Rate for Payer: Molina Healthcare Passport |
$358.28
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.86
|
|
|
REMOVAL OF WRIST PROSTHESIS(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
761P0596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.28 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$755.55
|
| Rate for Payer: Anthem Medicaid |
$358.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$833.51
|
| Rate for Payer: Healthspan PPO |
$684.37
|
| Rate for Payer: Humana Medicaid |
$358.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.45
|
| Rate for Payer: Molina Healthcare Passport |
$358.28
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.86
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761T2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$325.14 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Humana KY Medicaid |
$42.30
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$42.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761T2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$118.08 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$102.09
|
| Rate for Payer: First Health Commercial |
$116.85
|
| Rate for Payer: Humana Commercial |
$104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.24
|
| Rate for Payer: Ohio Health Group HMO |
$92.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.13
|
| Rate for Payer: PHCS Commercial |
$118.08
|
| Rate for Payer: United Healthcare All Payer |
$108.24
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761P2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$31.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$95.87
|
| Rate for Payer: Healthspan PPO |
$80.05
|
| Rate for Payer: Humana Medicaid |
$31.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.96
|
| Rate for Payer: Molina Healthcare Passport |
$31.33
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.64
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$31.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.00
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$95.87
|
| Rate for Payer: Healthspan PPO |
$80.05
|
| Rate for Payer: Humana Medicaid |
$31.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.96
|
| Rate for Payer: Molina Healthcare Passport |
$31.33
|
| Rate for Payer: Multiplan PHCS |
$169.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$198.10
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.64
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$283.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$325.14 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem Medicaid |
$97.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cigna Commercial |
$234.89
|
| Rate for Payer: First Health Commercial |
$268.85
|
| Rate for Payer: Humana Commercial |
$240.55
|
| Rate for Payer: Humana KY Medicaid |
$97.32
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$98.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$232.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$208.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$249.04
|
| Rate for Payer: Ohio Health Group HMO |
$212.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.73
|
| Rate for Payer: PHCS Commercial |
$271.68
|
| Rate for Payer: United Healthcare All Payer |
$249.04
|
|
