|
REMOVE CONTRACEPTIVE CAPSUL(T
|
Facility
|
OP
|
$874.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
761T0115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$851.79 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem Medicaid |
$300.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Humana KY Medicaid |
$300.57
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$303.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
REMOVE CONTRACEPTIVE CAPSUL(T
|
Facility
|
IP
|
$874.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
761T0115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$681.72
|
| Rate for Payer: Cash Price |
$437.00
|
| Rate for Payer: Cigna Commercial |
$725.42
|
| Rate for Payer: First Health Commercial |
$830.30
|
| Rate for Payer: Humana Commercial |
$742.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$769.12
|
| Rate for Payer: Ohio Health Group HMO |
$655.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.94
|
| Rate for Payer: PHCS Commercial |
$839.04
|
| Rate for Payer: United Healthcare All Payer |
$769.12
|
|
|
REMOVE CVA DEVICE OBSTRUCT
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
32000377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE CVA DEVICE OBSTRUCT
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
32000377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE DRUG IMPLANT DEVICE
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$1,493.76 |
| Rate for Payer: Aetna Commercial |
$1,198.12
|
| Rate for Payer: Anthem Medicaid |
$535.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,291.48
|
| Rate for Payer: First Health Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial |
$1,322.60
|
| Rate for Payer: Humana KY Medicaid |
$535.11
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$540.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.36
|
| Rate for Payer: PHCS Commercial |
$1,493.76
|
| Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
|
REMOVE DRUG IMPLANT DEVICE
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$1,556.00 |
| Rate for Payer: Aetna Commercial |
$156.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.51
|
| Rate for Payer: Anthem Medicaid |
$73.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,556.00
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$212.72
|
| Rate for Payer: Healthspan PPO |
$178.71
|
| Rate for Payer: Humana Medicaid |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$124.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.28
|
| Rate for Payer: Molina Healthcare Passport |
$73.80
|
| Rate for Payer: Multiplan PHCS |
$933.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,089.20
|
| Rate for Payer: UHCCP Medicaid |
$51.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.54
|
|
|
REMOVE DRUG IMPLANT DEVICE
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.28 |
| Max. Negotiated Rate |
$1,493.76 |
| Rate for Payer: Aetna Commercial |
$1,198.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.68
|
| Rate for Payer: Cash Price |
$778.00
|
| Rate for Payer: Cigna Commercial |
$1,291.48
|
| Rate for Payer: First Health Commercial |
$1,478.20
|
| Rate for Payer: Humana Commercial |
$1,322.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.36
|
| Rate for Payer: PHCS Commercial |
$1,493.76
|
| Rate for Payer: United Healthcare All Payer |
$1,369.28
|
|
|
REMOVE DRUG IMPLANT DEVICE(P
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
761P0118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.51 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$156.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.51
|
| Rate for Payer: Anthem Medicaid |
$73.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$390.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$212.72
|
| Rate for Payer: Healthspan PPO |
$178.71
|
| Rate for Payer: Humana Medicaid |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$124.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.28
|
| Rate for Payer: Molina Healthcare Passport |
$73.80
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$51.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.54
|
|
|
REMOVE DRUG IMPLANT DEVICE(T
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
761T0118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
REMOVE DRUG IMPLANT DEVICE(T
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
761T0118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
REMOVE EAR CANAL LESION(S)
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.32 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,217.95
|
| Rate for Payer: Anthem Medicaid |
$461.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,214.14
|
| Rate for Payer: Healthspan PPO |
$1,080.38
|
| Rate for Payer: Humana Medicaid |
$461.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,106.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.55
|
| Rate for Payer: Molina Healthcare Passport |
$461.32
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,662.50
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.93
|
|
|
REMOVE EAR CANAL LESION(S)(P
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
761P2407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.32 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,217.95
|
| Rate for Payer: Anthem Medicaid |
$461.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,214.14
|
| Rate for Payer: Healthspan PPO |
$1,080.38
|
| Rate for Payer: Humana Medicaid |
$461.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,106.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.55
|
| Rate for Payer: Molina Healthcare Passport |
$461.32
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,662.50
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.93
|
|
|
REMOVE ELBOW LESION
|
Facility
|
OP
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.64 |
| Max. Negotiated Rate |
$5,978.88 |
| Rate for Payer: Aetna Commercial |
$4,795.56
|
| Rate for Payer: Anthem Medicaid |
$2,141.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,857.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$5,169.24
|
| Rate for Payer: First Health Commercial |
$5,916.60
|
| Rate for Payer: Humana Commercial |
$5,293.80
|
| Rate for Payer: Humana KY Medicaid |
$2,141.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,163.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,106.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,596.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,184.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,480.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,930.68
|
| Rate for Payer: PHCS Commercial |
$5,978.88
|
| Rate for Payer: United Healthcare All Payer |
$5,480.64
|
|
|
REMOVE ELBOW LESION
|
Professional
|
Both
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$6,228.00 |
| Rate for Payer: Aetna Commercial |
$756.80
|
| Rate for Payer: Anthem Medicaid |
$371.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,228.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$831.35
|
| Rate for Payer: Healthspan PPO |
$685.50
|
| Rate for Payer: Humana Medicaid |
$371.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.35
|
| Rate for Payer: Molina Healthcare Passport |
$371.91
|
| Rate for Payer: Multiplan PHCS |
$3,736.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,359.60
|
| Rate for Payer: UHCCP Medicaid |
$2,179.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.63
|
|
|
REMOVE ELBOW LESION
|
Facility
|
IP
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$809.64 |
| Max. Negotiated Rate |
$5,978.88 |
| Rate for Payer: Aetna Commercial |
$4,795.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,857.84
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$5,169.24
|
| Rate for Payer: First Health Commercial |
$5,916.60
|
| Rate for Payer: Humana Commercial |
$5,293.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,106.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,596.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,868.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,480.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$809.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,930.68
|
| Rate for Payer: PHCS Commercial |
$5,978.88
|
| Rate for Payer: United Healthcare All Payer |
$5,480.64
|
|
|
REMOVE ELBOW LESION(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761P0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$756.80
|
| Rate for Payer: Anthem Medicaid |
$371.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$831.35
|
| Rate for Payer: Healthspan PPO |
$685.50
|
| Rate for Payer: Humana Medicaid |
$371.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.35
|
| Rate for Payer: Molina Healthcare Passport |
$371.91
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.63
|
|
|
REMOVE ELBOW LESION(T
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761T0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.14 |
| Max. Negotiated Rate |
$4,778.88 |
| Rate for Payer: Aetna Commercial |
$3,833.06
|
| Rate for Payer: Anthem Medicaid |
$1,711.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,882.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,489.00
|
| Rate for Payer: Cash Price |
$2,489.00
|
| Rate for Payer: Cigna Commercial |
$4,131.74
|
| Rate for Payer: First Health Commercial |
$4,729.10
|
| Rate for Payer: Humana Commercial |
$4,231.30
|
| Rate for Payer: Humana KY Medicaid |
$1,711.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,729.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,081.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,746.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$995.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,543.18
|
| Rate for Payer: PHCS Commercial |
$4,778.88
|
| Rate for Payer: United Healthcare All Payer |
$4,380.64
|
|
|
REMOVE ELBOW LESION(T
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761T0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.14 |
| Max. Negotiated Rate |
$4,778.88 |
| Rate for Payer: Aetna Commercial |
$3,833.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,882.84
|
| Rate for Payer: Cash Price |
$2,489.00
|
| Rate for Payer: Cigna Commercial |
$4,131.74
|
| Rate for Payer: First Health Commercial |
$4,729.10
|
| Rate for Payer: Humana Commercial |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,081.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,493.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$995.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,543.18
|
| Rate for Payer: PHCS Commercial |
$4,778.88
|
| Rate for Payer: United Healthcare All Payer |
$4,380.64
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$4,754.25 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,395.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| 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 |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Humana Medicare Advantage |
$3,395.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,075.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.08 |
| Max. Negotiated Rate |
$3,075.00 |
| Rate for Payer: Aetna Commercial |
$1,478.50
|
| Rate for Payer: Anthem Medicaid |
$524.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,075.00
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,404.18
|
| Rate for Payer: Healthspan PPO |
$1,453.65
|
| Rate for Payer: Humana Medicaid |
$524.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,209.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$534.56
|
| Rate for Payer: Molina Healthcare Passport |
$524.08
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,152.50
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.32
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
REMOVE ELCTRD TRANSVENOUSLY(P
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
761P1269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.08 |
| Max. Negotiated Rate |
$3,075.00 |
| Rate for Payer: Aetna Commercial |
$1,478.50
|
| Rate for Payer: Anthem Medicaid |
$524.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,075.00
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,404.18
|
| Rate for Payer: Healthspan PPO |
$1,453.65
|
| Rate for Payer: Humana Medicaid |
$524.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,209.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$534.56
|
| Rate for Payer: Molina Healthcare Passport |
$524.08
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,152.50
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.32
|
|
|
REMOVE ELTRD/THORACOTOMY
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,282.01 |
| Rate for Payer: Aetna Commercial |
$2,282.01
|
| Rate for Payer: Anthem Medicaid |
$909.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,590.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,161.15
|
| Rate for Payer: Healthspan PPO |
$2,243.66
|
| Rate for Payer: Humana Medicaid |
$909.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,923.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$927.55
|
| Rate for Payer: Molina Healthcare Passport |
$909.36
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,113.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.45
|
|
