|
REMOVE HIP PRESSURE SORE
|
Professional
|
Both
|
$7,307.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.28 |
| Max. Negotiated Rate |
$7,307.40 |
| Rate for Payer: Aetna Commercial |
$994.27
|
| Rate for Payer: Anthem Medicaid |
$353.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,307.40
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cigna Commercial |
$947.83
|
| Rate for Payer: Healthspan PPO |
$795.01
|
| Rate for Payer: Humana Medicaid |
$353.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.35
|
| Rate for Payer: Molina Healthcare Passport |
$353.28
|
| Rate for Payer: Multiplan PHCS |
$4,384.44
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,115.18
|
| Rate for Payer: UHCCP Medicaid |
$2,557.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.81
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
IP
|
$7,307.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$949.96 |
| Max. Negotiated Rate |
$7,015.10 |
| Rate for Payer: Aetna Commercial |
$5,626.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.77
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cigna Commercial |
$6,065.14
|
| Rate for Payer: First Health Commercial |
$6,942.03
|
| Rate for Payer: Humana Commercial |
$6,211.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$949.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.29
|
| Rate for Payer: PHCS Commercial |
$7,015.10
|
| Rate for Payer: United Healthcare All Payer |
$6,430.51
|
|
|
REMOVE HIP PRESSURE SORE(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761P0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.28 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$994.27
|
| Rate for Payer: Anthem Medicaid |
$353.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$947.83
|
| Rate for Payer: Healthspan PPO |
$795.01
|
| Rate for Payer: Humana Medicaid |
$353.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.35
|
| Rate for Payer: Molina Healthcare Passport |
$353.28
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.81
|
|
|
REMOVE HIP PRESSURE SORE(T
|
Facility
|
OP
|
$5,657.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761T0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.46 |
| Max. Negotiated Rate |
$5,431.10 |
| Rate for Payer: Aetna Commercial |
$4,356.20
|
| Rate for Payer: Anthem Medicaid |
$1,945.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,412.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna Commercial |
$4,695.64
|
| Rate for Payer: First Health Commercial |
$5,374.53
|
| Rate for Payer: Humana Commercial |
$4,808.79
|
| Rate for Payer: Humana KY Medicaid |
$1,945.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,965.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,978.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,131.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,753.79
|
| Rate for Payer: PHCS Commercial |
$5,431.10
|
| Rate for Payer: United Healthcare All Payer |
$4,978.51
|
|
|
REMOVE HIP PRESSURE SORE(T
|
Facility
|
IP
|
$5,657.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761T0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.46 |
| Max. Negotiated Rate |
$5,431.10 |
| Rate for Payer: Aetna Commercial |
$4,356.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,412.77
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna Commercial |
$4,695.64
|
| Rate for Payer: First Health Commercial |
$5,374.53
|
| Rate for Payer: Humana Commercial |
$4,808.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,978.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,131.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$735.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,753.79
|
| Rate for Payer: PHCS Commercial |
$5,431.10
|
| Rate for Payer: United Healthcare All Payer |
$4,978.51
|
|
|
REMOVE HIP PRESSURE ULCER
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.12 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.44
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
REMOVE HIP PRESSURE ULCER
|
Professional
|
Both
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.75 |
| Max. Negotiated Rate |
$4,524.00 |
| Rate for Payer: Aetna Commercial |
$1,410.67
|
| Rate for Payer: Anthem Medicaid |
$681.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,524.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$1,352.86
|
| Rate for Payer: Healthspan PPO |
$1,127.96
|
| Rate for Payer: Humana Medicaid |
$681.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,233.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$695.38
|
| Rate for Payer: Molina Healthcare Passport |
$681.75
|
| Rate for Payer: Multiplan PHCS |
$2,714.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,166.80
|
| Rate for Payer: UHCCP Medicaid |
$1,583.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$688.57
|
|
|
REMOVE HIP PRESSURE ULCER
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.12 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem Medicaid |
$1,555.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Humana KY Medicaid |
$1,555.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.44
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
REMOVE HIP PRESSURE ULCER(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761P0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.75 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,410.67
|
| Rate for Payer: Anthem Medicaid |
$681.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,352.86
|
| Rate for Payer: Healthspan PPO |
$1,127.96
|
| Rate for Payer: Humana Medicaid |
$681.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,233.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$695.38
|
| Rate for Payer: Molina Healthcare Passport |
$681.75
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$688.57
|
|
|
REMOVE HIP PRESSURE ULCER(T
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761T0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
REMOVE HIP PRESSURE ULCER(T
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761T0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$63.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$63.28
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Anthem Medicaid |
$9.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$184.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$20.45
|
| Rate for Payer: Humana Medicaid |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.48
|
| Rate for Payer: Molina Healthcare Passport |
$9.29
|
| Rate for Payer: Multiplan PHCS |
$110.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.80
|
| Rate for Payer: UHCCP Medicaid |
$64.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.38
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
REMOVE IMPACTED EAR WAX UNI(T
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
761T2412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
REMOVE IMPACTED EAR WAX UNI(T
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
761T2412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$63.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$63.28
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.04
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$486.01
|
| Rate for Payer: Anthem Medicaid |
$218.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Healthspan PPO |
$440.22
|
| Rate for Payer: Humana Medicaid |
$218.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.91
|
| Rate for Payer: Molina Healthcare Passport |
$218.54
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.73
|
|
|
REMOVE IMPLANT FROM FING HAN(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
761P0685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$486.01
|
| Rate for Payer: Anthem Medicaid |
$218.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Healthspan PPO |
$440.22
|
| Rate for Payer: Humana Medicaid |
$218.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.91
|
| Rate for Payer: Molina Healthcare Passport |
$218.54
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.73
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Professional
|
Both
|
$1,143.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.67 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$283.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.67
|
| Rate for Payer: Anthem Medicaid |
$136.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,143.00
|
| Rate for Payer: Cash Price |
$571.50
|
| Rate for Payer: Cash Price |
$571.50
|
| Rate for Payer: Cigna Commercial |
$319.63
|
| Rate for Payer: Healthspan PPO |
$277.12
|
| Rate for Payer: Humana Medicaid |
$136.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.53
|
| Rate for Payer: Molina Healthcare Passport |
$136.79
|
| Rate for Payer: Multiplan PHCS |
$685.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$800.10
|
| Rate for Payer: UHCCP Medicaid |
$109.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.16
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Facility
|
IP
|
$1,143.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$1,097.28 |
| Rate for Payer: Aetna Commercial |
$880.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$891.54
|
| Rate for Payer: Cash Price |
$571.50
|
| Rate for Payer: Cigna Commercial |
$948.69
|
| Rate for Payer: First Health Commercial |
$1,085.85
|
| Rate for Payer: Humana Commercial |
$971.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$937.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,005.84
|
| Rate for Payer: Ohio Health Group HMO |
$857.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.33
|
| Rate for Payer: PHCS Commercial |
$1,097.28
|
| Rate for Payer: United Healthcare All Payer |
$1,005.84
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Facility
|
OP
|
$1,143.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.59 |
| Max. Negotiated Rate |
$1,097.28 |
| Rate for Payer: Aetna Commercial |
$880.11
|
| Rate for Payer: Anthem Medicaid |
$393.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$891.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$571.50
|
| Rate for Payer: Cash Price |
$571.50
|
| Rate for Payer: Cigna Commercial |
$948.69
|
| Rate for Payer: First Health Commercial |
$1,085.85
|
| Rate for Payer: Humana Commercial |
$971.55
|
| Rate for Payer: Humana KY Medicaid |
$393.08
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$397.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$937.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,005.84
|
| Rate for Payer: Ohio Health Group HMO |
$857.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.33
|
| Rate for Payer: PHCS Commercial |
$1,097.28
|
| Rate for Payer: United Healthcare All Payer |
$1,005.84
|
|
|
REMOVE/INSERT DRUG IMPLANT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
761P0119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.67 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$283.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.67
|
| Rate for Payer: Anthem Medicaid |
$136.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$319.63
|
| Rate for Payer: Healthspan PPO |
$277.12
|
| Rate for Payer: Humana Medicaid |
$136.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.53
|
| Rate for Payer: Molina Healthcare Passport |
$136.79
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$109.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.16
|
|
|
REMOVE/INSERT DRUG IMPLANT(T
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
761T0119
|
|
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
|
|
