|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.95 |
| Max. Negotiated Rate |
$974.40 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$203.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$131.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$314.65
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,311.82 |
| Rate for Payer: Aetna Commercial |
$1,203.83
|
| Rate for Payer: Anthem Medicaid |
$553.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,015.00
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$1,311.82
|
| Rate for Payer: Healthspan PPO |
$1,090.41
|
| Rate for Payer: Humana Medicaid |
$553.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.43
|
| Rate for Payer: Molina Healthcare Passport |
$553.36
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$710.50
|
| Rate for Payer: UHCCP Medicaid |
$355.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.89
|
|
|
REMOVE FEMUR LESION/GRAFT(P
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
761P0825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,311.82 |
| Rate for Payer: Aetna Commercial |
$1,203.83
|
| Rate for Payer: Anthem Medicaid |
$553.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,015.00
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$1,311.82
|
| Rate for Payer: Healthspan PPO |
$1,090.41
|
| Rate for Payer: Humana Medicaid |
$553.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.43
|
| Rate for Payer: Molina Healthcare Passport |
$553.36
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$710.50
|
| Rate for Payer: UHCCP Medicaid |
$355.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.89
|
|
|
REMOVE FEMUR LESION(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
761P0824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Anthem Medicaid |
$440.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$966.71
|
| Rate for Payer: Healthspan PPO |
$796.78
|
| Rate for Payer: Humana Medicaid |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.17
|
| Rate for Payer: Molina Healthcare Passport |
$440.36
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.76
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$1,230.26
|
| Rate for Payer: Anthem Medicaid |
$584.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,139.54
|
| Rate for Payer: Healthspan PPO |
$1,037.50
|
| Rate for Payer: Humana Medicaid |
$584.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,089.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.96
|
| Rate for Payer: Molina Healthcare Passport |
$584.27
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.11
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
REMOVE FOREIGN BODY ADBOMEN(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
761P1994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$1,230.26
|
| Rate for Payer: Anthem Medicaid |
$584.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,139.54
|
| Rate for Payer: Healthspan PPO |
$1,037.50
|
| Rate for Payer: Humana Medicaid |
$584.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,089.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.96
|
| Rate for Payer: Molina Healthcare Passport |
$584.27
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.11
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$1,178.88 |
| Rate for Payer: Aetna Commercial |
$945.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$957.84
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cigna Commercial |
$1,019.24
|
| Rate for Payer: First Health Commercial |
$1,166.60
|
| Rate for Payer: Humana Commercial |
$1,043.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,006.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$906.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$368.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,080.64
|
| Rate for Payer: Ohio Health Group HMO |
$921.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.68
|
| Rate for Payer: PHCS Commercial |
$1,178.88
|
| Rate for Payer: United Healthcare All Payer |
$1,080.64
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$1,178.88 |
| Rate for Payer: Aetna Commercial |
$945.56
|
| Rate for Payer: Anthem Medicaid |
$422.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$957.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cigna Commercial |
$1,019.24
|
| Rate for Payer: First Health Commercial |
$1,166.60
|
| Rate for Payer: Humana Commercial |
$1,043.80
|
| Rate for Payer: Humana KY Medicaid |
$422.31
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$426.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,006.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$906.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$430.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,080.64
|
| Rate for Payer: Ohio Health Group HMO |
$921.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.68
|
| Rate for Payer: PHCS Commercial |
$1,178.88
|
| Rate for Payer: United Healthcare All Payer |
$1,080.64
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.01
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$28.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,228.00
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$28.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Molina Healthcare Passport |
$28.78
|
| Rate for Payer: Multiplan PHCS |
$736.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$859.60
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.07
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem Medicaid |
$333.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Humana KY Medicaid |
$333.93
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$337.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.01
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$971.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$28.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$971.00
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$28.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Molina Healthcare Passport |
$28.78
|
| Rate for Payer: Multiplan PHCS |
$582.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.70
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.07
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
45000299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$194.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$194.65
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$196.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
45000299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
REMOVE FOREIGN BODY FROM EY(P
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761P2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$28.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$685.00
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$28.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Molina Healthcare Passport |
$28.78
|
| Rate for Payer: Multiplan PHCS |
$411.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$479.50
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.07
|
|
|
REMOVE FOREIGN BODY FROM EY(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761P2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$28.78
|
| 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 |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$28.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.36
|
| Rate for Payer: Molina Healthcare Passport |
$28.78
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.07
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem Medicaid |
$186.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Humana KY Medicaid |
$186.74
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$188.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.59 |
| Max. Negotiated Rate |
$521.28 |
| Rate for Payer: Aetna Commercial |
$418.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.54
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$450.69
|
| Rate for Payer: First Health Commercial |
$515.85
|
| Rate for Payer: Humana Commercial |
$461.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$445.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.84
|
| Rate for Payer: Ohio Health Group HMO |
$407.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.33
|
| Rate for Payer: PHCS Commercial |
$521.28
|
| Rate for Payer: United Healthcare All Payer |
$477.84
|
|
|
REMOVE FOREIGN BODY UPPER ARM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
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 FOREIGN BODY UPPER ARM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| 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 |
$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 |
$1,402.02
|
| 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 |
$1,682.42
|
| 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 FOREIGN BODY UPPER ARM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.68
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| 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 |
$322.21
|
| Rate for Payer: Healthspan PPO |
$244.63
|
| Rate for Payer: Humana Medicaid |
$59.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.33
|
| Rate for Payer: Molina Healthcare Passport |
$59.15
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$76.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.74
|
|
