|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.79 |
| Max. Negotiated Rate |
$271.68 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$220.74
|
| 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: 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 |
$84.90
|
| 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
|
|
|
REMOVAL, SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Facility
|
OP
|
$851.79
|
|
|
Service Code
|
CPT 33286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.42 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Anthem Medicaid |
$12.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Humana Medicaid |
$12.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.68
|
| Rate for Payer: Molina Healthcare Passport |
$12.43
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.55
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.25
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Anthem Medicaid |
$8.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Humana Medicaid |
$8.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.99
|
| Rate for Payer: Molina Healthcare Passport |
$8.81
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.90
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$12.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$12.04
|
| Rate for Payer: Kentucky WC Medicaid |
$12.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
REMOVAL TUNNELED CVC
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.26 |
| Max. Negotiated Rate |
$2,401.92 |
| Rate for Payer: Aetna Commercial |
$1,926.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,951.56
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$2,076.66
|
| Rate for Payer: First Health Commercial |
$2,376.90
|
| Rate for Payer: Humana Commercial |
$2,126.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,051.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,846.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,201.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,876.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.62
|
| Rate for Payer: PHCS Commercial |
$2,401.92
|
| Rate for Payer: United Healthcare All Payer |
$2,201.76
|
|
|
REMOVAL TUNNELED CVC
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.26 |
| Max. Negotiated Rate |
$2,401.92 |
| Rate for Payer: Aetna Commercial |
$1,926.54
|
| Rate for Payer: Anthem Medicaid |
$860.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,951.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$2,076.66
|
| Rate for Payer: First Health Commercial |
$2,376.90
|
| Rate for Payer: Humana Commercial |
$2,126.70
|
| Rate for Payer: Humana KY Medicaid |
$860.44
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$869.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,051.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,846.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,201.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,876.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.62
|
| Rate for Payer: PHCS Commercial |
$2,401.92
|
| Rate for Payer: United Healthcare All Payer |
$2,201.76
|
|
|
REMOVAL TUNNELED CVC
|
Professional
|
Both
|
$2,502.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Aetna Commercial |
$218.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.79
|
| Rate for Payer: Anthem Medicaid |
$108.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,502.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$203.61
|
| Rate for Payer: Humana Medicaid |
$108.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.18
|
| Rate for Payer: Molina Healthcare Passport |
$108.02
|
| Rate for Payer: Multiplan PHCS |
$1,501.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,751.40
|
| Rate for Payer: UHCCP Medicaid |
$95.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.10
|
|
|
REMOVAL TUNNELED CVC(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761P1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna Commercial |
$218.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.79
|
| Rate for Payer: Anthem Medicaid |
$108.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$203.61
|
| Rate for Payer: Humana Medicaid |
$108.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.18
|
| Rate for Payer: Molina Healthcare Passport |
$108.02
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$95.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.10
|
|
|
REMOVAL TUNNELED CVC(T
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761T1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.81 |
| Max. Negotiated Rate |
$2,051.52 |
| Rate for Payer: Aetna Commercial |
$1,645.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.86
|
| Rate for Payer: Cash Price |
$1,068.50
|
| Rate for Payer: Cigna Commercial |
$1,773.71
|
| Rate for Payer: First Health Commercial |
$2,030.15
|
| Rate for Payer: Humana Commercial |
$1,816.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,880.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.47
|
| Rate for Payer: PHCS Commercial |
$2,051.52
|
| Rate for Payer: United Healthcare All Payer |
$1,880.56
|
|
|
REMOVAL TUNNELED CVC(T
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761T1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.81 |
| Max. Negotiated Rate |
$2,051.52 |
| Rate for Payer: Aetna Commercial |
$1,645.49
|
| Rate for Payer: Anthem Medicaid |
$734.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,068.50
|
| Rate for Payer: Cash Price |
$1,068.50
|
| Rate for Payer: Cigna Commercial |
$1,773.71
|
| Rate for Payer: First Health Commercial |
$2,030.15
|
| Rate for Payer: Humana Commercial |
$1,816.45
|
| Rate for Payer: Humana KY Medicaid |
$734.91
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$742.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,880.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.47
|
| Rate for Payer: PHCS Commercial |
$2,051.52
|
| Rate for Payer: United Healthcare All Payer |
$1,880.56
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
REMOVAL VAD
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL VAD
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL VAD
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.56 |
| Max. Negotiated Rate |
$6,190.40 |
| Rate for Payer: Aetna Commercial |
$6,190.40
|
| Rate for Payer: Anthem Medicaid |
$837.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$5,781.70
|
| Rate for Payer: Healthspan PPO |
$6,086.37
|
| Rate for Payer: Humana Medicaid |
$837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,104.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$854.31
|
| Rate for Payer: Molina Healthcare Passport |
$837.56
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$845.94
|
|
|
REMOVAL VAD(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
761P1331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.56 |
| Max. Negotiated Rate |
$6,190.40 |
| Rate for Payer: Aetna Commercial |
$6,190.40
|
| Rate for Payer: Anthem Medicaid |
$837.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,000.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$5,781.70
|
| Rate for Payer: Healthspan PPO |
$6,086.37
|
| Rate for Payer: Humana Medicaid |
$837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,104.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$854.31
|
| Rate for Payer: Molina Healthcare Passport |
$837.56
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$845.94
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.17 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$510.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$242.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$726.59
|
| Rate for Payer: Healthspan PPO |
$451.14
|
| Rate for Payer: Humana Medicaid |
$242.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$425.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.24
|
| Rate for Payer: Molina Healthcare Passport |
$242.39
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$180.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.81
|
|
|
REMOVE ABDOMINAL WALL LESION(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
761P0429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.17 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$510.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$242.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$726.59
|
| Rate for Payer: Healthspan PPO |
$451.14
|
| Rate for Payer: Humana Medicaid |
$242.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$425.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.24
|
| Rate for Payer: Molina Healthcare Passport |
$242.39
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$180.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.81
|
|
|
REMOVE ADENOIDS UNDER 12 YRS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
REMOVE ADENOIDS UNDER 12 YRS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$293.71
|
| Rate for Payer: Healthspan PPO |
$250.53
|
| Rate for Payer: Humana Medicaid |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.84
|
| Rate for Payer: Molina Healthcare Passport |
$147.88
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.36
|
|
