|
REMOVE/INSERT DRUG IMPLANT(T
|
Facility
|
OP
|
$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 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 INTRA-AORTIC BALLOON
|
Professional
|
Both
|
$921.79
|
|
|
Service Code
|
HCPCS 33974
|
| Hospital Charge Code |
76102728
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.63 |
| Max. Negotiated Rate |
$1,538.19 |
| Rate for Payer: Aetna Commercial |
$1,538.19
|
| Rate for Payer: Anthem Medicaid |
$543.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$921.79
|
| Rate for Payer: Cash Price |
$460.90
|
| Rate for Payer: Cash Price |
$460.90
|
| Rate for Payer: Cigna Commercial |
$1,440.15
|
| Rate for Payer: Healthspan PPO |
$1,512.34
|
| Rate for Payer: Humana Medicaid |
$543.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$554.48
|
| Rate for Payer: Molina Healthcare Passport |
$543.61
|
| Rate for Payer: Multiplan PHCS |
$553.07
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$645.25
|
| Rate for Payer: UHCCP Medicaid |
$322.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.05
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.82
|
| Rate for Payer: Anthem Medicaid |
$250.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,580.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$521.35
|
| Rate for Payer: Healthspan PPO |
$1,497.61
|
| Rate for Payer: Humana Medicaid |
$250.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.01
|
| Rate for Payer: Molina Healthcare Passport |
$250.01
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,106.00
|
| Rate for Payer: UHCCP Medicaid |
$185.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.51
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem Medicaid |
$543.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Humana KY Medicaid |
$543.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$548.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
761P2766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.82
|
| Rate for Payer: Anthem Medicaid |
$250.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,580.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$521.35
|
| Rate for Payer: Healthspan PPO |
$1,497.61
|
| Rate for Payer: Humana Medicaid |
$250.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.01
|
| Rate for Payer: Molina Healthcare Passport |
$250.01
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,106.00
|
| Rate for Payer: UHCCP Medicaid |
$185.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.51
|
|
|
REMOVE KIDNEY OPEN
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 50220
|
| Hospital Charge Code |
76102893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem Medicaid |
$885.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Kentucky WC Medicaid |
$894.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$903.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVE KIDNEY OPEN
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 50220
|
| Hospital Charge Code |
76102893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVE KIDNEY OPEN
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 50220
|
| Hospital Charge Code |
76102893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.66 |
| Max. Negotiated Rate |
$2,575.00 |
| Rate for Payer: Aetna Commercial |
$1,668.44
|
| Rate for Payer: Anthem Medicaid |
$860.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,575.00
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,494.12
|
| Rate for Payer: Healthspan PPO |
$1,334.07
|
| Rate for Payer: Humana Medicaid |
$860.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,419.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$877.87
|
| Rate for Payer: Molina Healthcare Passport |
$860.66
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,802.50
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$869.27
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVE LOWER LEG BONE LESION
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$874.21
|
| Rate for Payer: Anthem Medicaid |
$460.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$962.39
|
| Rate for Payer: Healthspan PPO |
$791.84
|
| Rate for Payer: Humana Medicaid |
$460.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$735.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$469.63
|
| Rate for Payer: Molina Healthcare Passport |
$460.42
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.02
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| 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 |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVE LOWER LEG BONE LESIO(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
761P0903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$874.21
|
| Rate for Payer: Anthem Medicaid |
$460.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$962.39
|
| Rate for Payer: Healthspan PPO |
$791.84
|
| Rate for Payer: Humana Medicaid |
$460.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$735.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$469.63
|
| Rate for Payer: Molina Healthcare Passport |
$460.42
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.02
|
|
|
REMOVE LUNG ARTERY EMBOLI
|
Professional
|
Both
|
$2,675.00
|
|
|
Service Code
|
HCPCS 33910
|
| Hospital Charge Code |
76102761
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$2,834.80 |
| Rate for Payer: Aetna Commercial |
$2,834.80
|
| Rate for Payer: Anthem Medicaid |
$1,101.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,675.00
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cigna Commercial |
$2,618.28
|
| Rate for Payer: Healthspan PPO |
$2,787.17
|
| Rate for Payer: Humana Medicaid |
$1,101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,368.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,123.73
|
| Rate for Payer: Molina Healthcare Passport |
$1,101.70
|
| Rate for Payer: Multiplan PHCS |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,872.50
|
| Rate for Payer: UHCCP Medicaid |
$936.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,112.72
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
IP
|
$2,480.38
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.45 |
| Max. Negotiated Rate |
$2,381.16 |
| Rate for Payer: Aetna Commercial |
$1,909.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,934.70
|
| Rate for Payer: Cash Price |
$1,240.19
|
| Rate for Payer: Cigna Commercial |
$2,058.72
|
| Rate for Payer: First Health Commercial |
$2,356.36
|
| Rate for Payer: Humana Commercial |
$2,108.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,033.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,830.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$744.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,182.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,860.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.92
|
| Rate for Payer: PHCS Commercial |
$2,381.16
|
| Rate for Payer: United Healthcare All Payer |
$2,182.73
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
OP
|
$2,480.38
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.45 |
| Max. Negotiated Rate |
$2,381.16 |
| Rate for Payer: Aetna Commercial |
$1,909.89
|
| Rate for Payer: Anthem Medicaid |
$853.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,934.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,240.19
|
| Rate for Payer: Cash Price |
$1,240.19
|
| Rate for Payer: Cigna Commercial |
$2,058.72
|
| Rate for Payer: First Health Commercial |
$2,356.36
|
| Rate for Payer: Humana Commercial |
$2,108.32
|
| Rate for Payer: Humana KY Medicaid |
$853.00
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$861.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,033.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,830.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$870.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,182.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,860.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$496.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.92
|
| Rate for Payer: PHCS Commercial |
$2,381.16
|
| Rate for Payer: United Healthcare All Payer |
$2,182.73
|
|
|
REMOVE LUNG CATHETER
|
Professional
|
Both
|
$2,480.38
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$2,480.38 |
| Rate for Payer: Aetna Commercial |
$275.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.94
|
| Rate for Payer: Anthem Medicaid |
$118.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,480.38
|
| Rate for Payer: Cash Price |
$1,240.19
|
| Rate for Payer: Cash Price |
$1,240.19
|
| Rate for Payer: Cigna Commercial |
$311.71
|
| Rate for Payer: Healthspan PPO |
$189.31
|
| Rate for Payer: Humana Medicaid |
$118.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.26
|
| Rate for Payer: Molina Healthcare Passport |
$118.88
|
| Rate for Payer: Multiplan PHCS |
$1,488.23
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,736.27
|
| Rate for Payer: UHCCP Medicaid |
$83.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.07
|
|
|
REMOVE LUNG CATHETER(P
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761P1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$275.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.94
|
| Rate for Payer: Anthem Medicaid |
$118.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$311.71
|
| Rate for Payer: Healthspan PPO |
$189.31
|
| Rate for Payer: Humana Medicaid |
$118.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.26
|
| Rate for Payer: Molina Healthcare Passport |
$118.88
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$83.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.07
|
|
|
REMOVE LUNG CATHETER(T
|
Facility
|
OP
|
$1,900.38
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761T1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem Medicaid |
$653.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Humana KY Medicaid |
$653.54
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$660.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
REMOVE LUNG CATHETER(T
|
Facility
|
IP
|
$1,900.38
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761T1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
REMOVE LYMPY NODE DEEP
|
Professional
|
Both
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$7,366.00 |
| Rate for Payer: Aetna Commercial |
$613.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$193.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,366.00
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$581.51
|
| Rate for Payer: Healthspan PPO |
$584.31
|
| Rate for Payer: Humana Medicaid |
$193.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$540.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.37
|
| Rate for Payer: Molina Healthcare Passport |
$193.50
|
| Rate for Payer: Multiplan PHCS |
$4,419.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,156.20
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.44
|
|
|
REMOVE LYMPY NODE DEEP
|
Facility
|
OP
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.58 |
| Max. Negotiated Rate |
$7,071.36 |
| Rate for Payer: Aetna Commercial |
$5,671.82
|
| Rate for Payer: Anthem Medicaid |
$2,533.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,745.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$6,113.78
|
| Rate for Payer: First Health Commercial |
$6,997.70
|
| Rate for Payer: Humana Commercial |
$6,261.10
|
| Rate for Payer: Humana KY Medicaid |
$2,533.17
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,558.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,040.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,436.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,583.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,482.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.46
|
| Rate for Payer: PHCS Commercial |
$7,071.36
|
| Rate for Payer: United Healthcare All Payer |
$6,482.08
|
|
|
REMOVE LYMPY NODE DEEP
|
Facility
|
IP
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.58 |
| Max. Negotiated Rate |
$7,071.36 |
| Rate for Payer: Aetna Commercial |
$5,671.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,745.48
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$6,113.78
|
| Rate for Payer: First Health Commercial |
$6,997.70
|
| Rate for Payer: Humana Commercial |
$6,261.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,040.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,436.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,209.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,482.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,473.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,283.46
|
| Rate for Payer: PHCS Commercial |
$7,071.36
|
| Rate for Payer: United Healthcare All Payer |
$6,482.08
|
|
|
REMOVE LYMPY NODE DEEP(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
761P1595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$613.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$193.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.51
|
| Rate for Payer: Healthspan PPO |
$584.31
|
| Rate for Payer: Humana Medicaid |
$193.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$540.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.37
|
| Rate for Payer: Molina Healthcare Passport |
$193.50
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.44
|
|
|
REMOVE LYMPY NODE DEEP(T
|
Facility
|
IP
|
$6,666.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
761T1595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.58 |
| Max. Negotiated Rate |
$6,399.36 |
| Rate for Payer: Aetna Commercial |
$5,132.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.48
|
| Rate for Payer: Cash Price |
$3,333.00
|
| Rate for Payer: Cigna Commercial |
$5,532.78
|
| Rate for Payer: First Health Commercial |
$6,332.70
|
| Rate for Payer: Humana Commercial |
$5,666.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,466.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,919.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,866.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,066.46
|
| Rate for Payer: PHCS Commercial |
$6,399.36
|
| Rate for Payer: United Healthcare All Payer |
$5,866.08
|
|
