|
REMOVE ADENOIDS UNDER 12 YRS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| 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 |
$225.00
|
| 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: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| 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 |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| 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(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
761P1710
|
|
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
|
|
|
REMOVE ANKLE JOINT LINING
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 27626
|
| Hospital Charge Code |
76102747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$1,051.09 |
| Rate for Payer: Aetna Commercial |
$953.43
|
| Rate for Payer: Anthem Medicaid |
$570.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$1,051.09
|
| Rate for Payer: Healthspan PPO |
$863.61
|
| Rate for Payer: Humana Medicaid |
$570.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.21
|
| Rate for Payer: Molina Healthcare Passport |
$570.79
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.50
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
76102099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REMOVE BLADDER STONE
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
76102099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.73 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$792.49
|
| Rate for Payer: Anthem Medicaid |
$499.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$709.79
|
| Rate for Payer: Healthspan PPO |
$633.66
|
| Rate for Payer: Humana Medicaid |
$499.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.72
|
| Rate for Payer: Molina Healthcare Passport |
$499.73
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.73
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
REMOVE BLADDER STONE
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna Commercial |
$581.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$377.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$519.96
|
| Rate for Payer: Healthspan PPO |
$1,193.83
|
| Rate for Payer: Humana Medicaid |
$377.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.10
|
| Rate for Payer: Molina Healthcare Passport |
$377.55
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,309.00
|
| Rate for Payer: UHCCP Medicaid |
$182.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.33
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
76102099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REMOVE BLADDER STONE(P
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
761P2098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna Commercial |
$581.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$377.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$519.96
|
| Rate for Payer: Healthspan PPO |
$1,193.83
|
| Rate for Payer: Humana Medicaid |
$377.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.10
|
| Rate for Payer: Molina Healthcare Passport |
$377.55
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,309.00
|
| Rate for Payer: UHCCP Medicaid |
$182.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.33
|
|
|
REMOVE BLADDER STONE(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
761P2099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$499.73 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$792.49
|
| Rate for Payer: Anthem Medicaid |
$499.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$709.79
|
| Rate for Payer: Healthspan PPO |
$633.66
|
| Rate for Payer: Humana Medicaid |
$499.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$509.72
|
| Rate for Payer: Molina Healthcare Passport |
$499.73
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$504.73
|
|
|
REMOVE BONE FIXATION DEVICE
|
Professional
|
Both
|
$6,534.38
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
76100354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$6,534.38 |
| Rate for Payer: Aetna Commercial |
$491.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$174.24
|
| Rate for Payer: Anthem Medicaid |
$191.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,534.38
|
| Rate for Payer: Cash Price |
$3,267.19
|
| Rate for Payer: Cash Price |
$3,267.19
|
| Rate for Payer: Cigna Commercial |
$542.12
|
| Rate for Payer: Healthspan PPO |
$545.59
|
| Rate for Payer: Humana Medicaid |
$191.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$415.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.33
|
| Rate for Payer: Molina Healthcare Passport |
$191.50
|
| Rate for Payer: Multiplan PHCS |
$3,920.63
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,574.07
|
| Rate for Payer: UHCCP Medicaid |
$182.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.42
|
|
|
REMOVE BONE FIXATION DEVICE
|
Facility
|
IP
|
$6,534.38
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
76100354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.47 |
| Max. Negotiated Rate |
$6,273.00 |
| Rate for Payer: Aetna Commercial |
$5,031.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,096.82
|
| Rate for Payer: Cash Price |
$3,267.19
|
| Rate for Payer: Cigna Commercial |
$5,423.54
|
| Rate for Payer: First Health Commercial |
$6,207.66
|
| Rate for Payer: Humana Commercial |
$5,554.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,358.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,822.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,960.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,750.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,900.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.66
|
| Rate for Payer: PHCS Commercial |
$6,273.00
|
| Rate for Payer: United Healthcare All Payer |
$5,750.25
|
|
|
REMOVE BONE FIXATION DEVICE
|
Facility
|
OP
|
$6,534.38
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
76100354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$849.47 |
| Max. Negotiated Rate |
$6,273.00 |
| Rate for Payer: Aetna Commercial |
$5,031.47
|
| Rate for Payer: Anthem Medicaid |
$2,247.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,096.82
|
| 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 |
$3,267.19
|
| Rate for Payer: Cash Price |
$3,267.19
|
| Rate for Payer: Cigna Commercial |
$5,423.54
|
| Rate for Payer: First Health Commercial |
$6,207.66
|
| Rate for Payer: Humana Commercial |
$5,554.22
|
| Rate for Payer: Humana KY Medicaid |
$2,247.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,270.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,358.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,822.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,292.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,750.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,900.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$849.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,025.66
|
| Rate for Payer: PHCS Commercial |
$6,273.00
|
| Rate for Payer: United Healthcare All Payer |
$5,750.25
|
|
|
REMOVE BONE FIXATION DEVICE(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
761P0354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$491.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$174.24
|
| Rate for Payer: Anthem Medicaid |
$191.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$542.12
|
| Rate for Payer: Healthspan PPO |
$545.59
|
| Rate for Payer: Humana Medicaid |
$191.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$415.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.33
|
| Rate for Payer: Molina Healthcare Passport |
$191.50
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$182.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.42
|
|
|
REMOVE BONE FIXATION DEVICE(T
|
Facility
|
OP
|
$5,759.38
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
761T0354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$5,529.00 |
| Rate for Payer: Aetna Commercial |
$4,434.72
|
| Rate for Payer: Anthem Medicaid |
$1,980.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,492.32
|
| 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 |
$2,879.69
|
| Rate for Payer: Cash Price |
$2,879.69
|
| Rate for Payer: Cigna Commercial |
$4,780.29
|
| Rate for Payer: First Health Commercial |
$5,471.41
|
| Rate for Payer: Humana Commercial |
$4,895.47
|
| Rate for Payer: Humana KY Medicaid |
$1,980.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,000.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,722.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,250.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,020.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,068.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,319.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,151.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.41
|
| Rate for Payer: PHCS Commercial |
$5,529.00
|
| Rate for Payer: United Healthcare All Payer |
$5,068.25
|
|
|
REMOVE BONE FIXATION DEVICE(T
|
Facility
|
IP
|
$5,759.38
|
|
|
Service Code
|
HCPCS 20694
|
| Hospital Charge Code |
761T0354
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$748.72 |
| Max. Negotiated Rate |
$5,529.00 |
| Rate for Payer: Aetna Commercial |
$4,434.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,492.32
|
| Rate for Payer: Cash Price |
$2,879.69
|
| Rate for Payer: Cigna Commercial |
$4,780.29
|
| Rate for Payer: First Health Commercial |
$5,471.41
|
| Rate for Payer: Humana Commercial |
$4,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,722.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,250.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,727.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,068.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,319.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,151.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,785.41
|
| Rate for Payer: PHCS Commercial |
$5,529.00
|
| Rate for Payer: United Healthcare All Payer |
$5,068.25
|
|
|
REMOVE BY LIGAT INT HEM GRP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
76101941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$225.00
|
| 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: Humana KY Medicaid |
$154.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| 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 |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| 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 BY LIGAT INT HEM GRP
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
76101941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.80 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$287.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.80
|
| Rate for Payer: Anthem Medicaid |
$260.96
|
| 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 |
$325.38
|
| Rate for Payer: Healthspan PPO |
$311.00
|
| Rate for Payer: Humana Medicaid |
$260.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.18
|
| Rate for Payer: Molina Healthcare Passport |
$260.96
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$184.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.57
|
|
|
REMOVE BY LIGAT INT HEM GRP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
76101941
|
|
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 BY LIGAT INT HEM GRP(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46945
|
| Hospital Charge Code |
761P1941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.80 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$287.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.80
|
| Rate for Payer: Anthem Medicaid |
$260.96
|
| 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 |
$325.38
|
| Rate for Payer: Healthspan PPO |
$311.00
|
| Rate for Payer: Humana Medicaid |
$260.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.18
|
| Rate for Payer: Molina Healthcare Passport |
$260.96
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$184.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.57
|
|
|
REMOVE CONTRACEPTIVE CAPSULE
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,053.27
|
| Rate for Payer: First Health Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial |
$1,078.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,040.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$936.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,116.72
|
| Rate for Payer: Ohio Health Group HMO |
$951.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.39
|
| Rate for Payer: PHCS Commercial |
$1,218.24
|
| Rate for Payer: United Healthcare All Payer |
$1,116.72
|
|
|
REMOVE CONTRACEPTIVE CAPSULE
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.97 |
| Max. Negotiated Rate |
$1,218.24 |
| Rate for Payer: Aetna Commercial |
$977.13
|
| Rate for Payer: Anthem Medicaid |
$436.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$989.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,053.27
|
| Rate for Payer: First Health Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial |
$1,078.65
|
| Rate for Payer: Humana KY Medicaid |
$436.41
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$440.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,040.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$936.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,116.72
|
| Rate for Payer: Ohio Health Group HMO |
$951.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.39
|
| Rate for Payer: PHCS Commercial |
$1,218.24
|
| Rate for Payer: United Healthcare All Payer |
$1,116.72
|
|
|
REMOVE CONTRACEPTIVE CAPSULE
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$1,269.00 |
| Rate for Payer: Aetna Commercial |
$147.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.05
|
| Rate for Payer: Anthem Medicaid |
$93.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,269.00
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$201.21
|
| Rate for Payer: Healthspan PPO |
$170.73
|
| Rate for Payer: Humana Medicaid |
$93.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.73
|
| Rate for Payer: Molina Healthcare Passport |
$93.85
|
| Rate for Payer: Multiplan PHCS |
$761.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$888.30
|
| Rate for Payer: UHCCP Medicaid |
$54.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.79
|
|
|
REMOVE CONTRACEPTIVE CAPSUL(P
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
761P0115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Aetna Commercial |
$147.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.05
|
| Rate for Payer: Anthem Medicaid |
$93.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.00
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$201.21
|
| Rate for Payer: Healthspan PPO |
$170.73
|
| Rate for Payer: Humana Medicaid |
$93.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.73
|
| Rate for Payer: Molina Healthcare Passport |
$93.85
|
| Rate for Payer: Multiplan PHCS |
$237.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$276.50
|
| Rate for Payer: UHCCP Medicaid |
$54.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.79
|
|
