|
REMOVE LYMPY NODE DEEP(T
|
Facility
|
OP
|
$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 Medicaid |
$2,292.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.48
|
| 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 |
$3,333.00
|
| 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: Humana KY Medicaid |
$2,292.44
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,315.77
|
| 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 |
$3,955.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.43
|
| 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
|
|
|
REMOVE MESH FROM ABD WALL
|
Professional
|
Both
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.69 |
| Max. Negotiated Rate |
$4,295.00 |
| Rate for Payer: Aetna Commercial |
$415.56
|
| Rate for Payer: Anthem Medicaid |
$215.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,295.00
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Healthspan PPO |
$332.28
|
| Rate for Payer: Humana Medicaid |
$215.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.00
|
| Rate for Payer: Molina Healthcare Passport |
$215.69
|
| Rate for Payer: Multiplan PHCS |
$2,577.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,006.50
|
| Rate for Payer: UHCCP Medicaid |
$1,503.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.85
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
IP
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.35 |
| Max. Negotiated Rate |
$4,123.20 |
| Rate for Payer: Aetna Commercial |
$3,307.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.10
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$3,564.85
|
| Rate for Payer: First Health Commercial |
$4,080.25
|
| Rate for Payer: Humana Commercial |
$3,650.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.45
|
| Rate for Payer: PHCS Commercial |
$4,123.20
|
| Rate for Payer: United Healthcare All Payer |
$3,779.60
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
OP
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$558.35 |
| Max. Negotiated Rate |
$4,123.20 |
| Rate for Payer: Aetna Commercial |
$3,307.15
|
| Rate for Payer: Anthem Medicaid |
$1,477.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.10
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$3,564.85
|
| Rate for Payer: First Health Commercial |
$4,080.25
|
| Rate for Payer: Humana Commercial |
$3,650.75
|
| Rate for Payer: Humana KY Medicaid |
$1,477.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,492.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.45
|
| Rate for Payer: PHCS Commercial |
$4,123.20
|
| Rate for Payer: United Healthcare All Payer |
$3,779.60
|
|
|
REMOVE MESH FROM ABD WALL(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761P0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$415.56
|
| Rate for Payer: Anthem Medicaid |
$215.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Healthspan PPO |
$332.28
|
| Rate for Payer: Humana Medicaid |
$215.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.00
|
| Rate for Payer: Molina Healthcare Passport |
$215.69
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.85
|
|
|
REMOVE MESH FROM ABD WALL(T
|
Facility
|
OP
|
$3,745.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761T0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$486.85 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$2,883.65
|
| Rate for Payer: Anthem Medicaid |
$1,287.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.10
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cigna Commercial |
$3,108.35
|
| Rate for Payer: First Health Commercial |
$3,557.75
|
| Rate for Payer: Humana Commercial |
$3,183.25
|
| Rate for Payer: Humana KY Medicaid |
$1,287.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,301.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,070.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,763.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,313.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,295.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.95
|
| Rate for Payer: PHCS Commercial |
$3,595.20
|
| Rate for Payer: United Healthcare All Payer |
$3,295.60
|
|
|
REMOVE MESH FROM ABD WALL(T
|
Facility
|
IP
|
$3,745.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761T0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$486.85 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$2,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.10
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cigna Commercial |
$3,108.35
|
| Rate for Payer: First Health Commercial |
$3,557.75
|
| Rate for Payer: Humana Commercial |
$3,183.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,070.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,763.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,295.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.95
|
| Rate for Payer: PHCS Commercial |
$3,595.20
|
| Rate for Payer: United Healthcare All Payer |
$3,295.60
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$1,376.76
|
| Rate for Payer: Anthem Medicaid |
$614.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,484.04
|
| Rate for Payer: First Health Commercial |
$1,698.60
|
| Rate for Payer: Humana Commercial |
$1,519.80
|
| Rate for Payer: Humana KY Medicaid |
$614.89
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.28
|
| Rate for Payer: PHCS Commercial |
$1,716.48
|
| Rate for Payer: United Healthcare All Payer |
$1,573.44
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$90.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.87
|
| Rate for Payer: Anthem Medicaid |
$37.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$93.30
|
| Rate for Payer: Healthspan PPO |
$130.05
|
| Rate for Payer: Humana Medicaid |
$37.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.77
|
| Rate for Payer: Molina Healthcare Passport |
$37.03
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$29.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.40
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.42 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$1,191.81
|
| Rate for Payer: Anthem Medicaid |
$525.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,788.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,057.93
|
| Rate for Payer: Healthspan PPO |
$1,153.98
|
| Rate for Payer: Humana Medicaid |
$525.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$995.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$535.93
|
| Rate for Payer: Molina Healthcare Passport |
$525.42
|
| Rate for Payer: Multiplan PHCS |
$1,072.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,251.60
|
| Rate for Payer: UHCCP Medicaid |
$625.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.67
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 36510
|
| Hospital Charge Code |
76102876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
REMOVE MUTI-COMP PENIS PROS
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
HCPCS 54406
|
| Hospital Charge Code |
76102878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$1,716.48 |
| Rate for Payer: Aetna Commercial |
$1,376.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.64
|
| Rate for Payer: Cash Price |
$894.00
|
| Rate for Payer: Cigna Commercial |
$1,484.04
|
| Rate for Payer: First Health Commercial |
$1,698.60
|
| Rate for Payer: Humana Commercial |
$1,519.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.28
|
| Rate for Payer: PHCS Commercial |
$1,716.48
|
| Rate for Payer: United Healthcare All Payer |
$1,573.44
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$771.84 |
| Rate for Payer: Aetna Commercial |
$619.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.12
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$667.32
|
| Rate for Payer: First Health Commercial |
$763.80
|
| Rate for Payer: Humana Commercial |
$683.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$659.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$707.52
|
| Rate for Payer: Ohio Health Group HMO |
$603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.24
|
| Rate for Payer: PHCS Commercial |
$771.84
|
| Rate for Payer: United Healthcare All Payer |
$707.52
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$771.84 |
| Rate for Payer: Aetna Commercial |
$619.08
|
| Rate for Payer: Anthem Medicaid |
$276.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$667.32
|
| Rate for Payer: First Health Commercial |
$763.80
|
| Rate for Payer: Humana Commercial |
$683.40
|
| Rate for Payer: Humana KY Medicaid |
$276.50
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$279.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$659.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$593.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$707.52
|
| Rate for Payer: Ohio Health Group HMO |
$603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.24
|
| Rate for Payer: PHCS Commercial |
$771.84
|
| Rate for Payer: United Healthcare All Payer |
$707.52
|
|
|
REMOVE NASAL FOREIGN BODY
|
Professional
|
Both
|
$804.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
76101124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.02
|
| Rate for Payer: Anthem Medicaid |
$36.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$804.00
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Healthspan PPO |
$251.84
|
| Rate for Payer: Humana Medicaid |
$36.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.16
|
| Rate for Payer: Molina Healthcare Passport |
$36.43
|
| Rate for Payer: Multiplan PHCS |
$482.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$562.80
|
| Rate for Payer: UHCCP Medicaid |
$67.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.79
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
45000207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$58.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$58.46
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.70
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
REMOVE NASAL FOREIGN BODY
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
45000207
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.70
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
REMOVE NASAL FOREIGN BODY(P
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761P1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.02
|
| Rate for Payer: Anthem Medicaid |
$36.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$465.00
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Healthspan PPO |
$251.84
|
| Rate for Payer: Humana Medicaid |
$36.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$154.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.16
|
| Rate for Payer: Molina Healthcare Passport |
$36.43
|
| Rate for Payer: Multiplan PHCS |
$279.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$325.50
|
| Rate for Payer: UHCCP Medicaid |
$67.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.79
|
|
|
REMOVE NASAL FOREIGN BODY(T
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761T1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem Medicaid |
$116.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Humana KY Medicaid |
$116.58
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$117.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
REMOVE NASAL FOREIGN BODY(T
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS 30300
|
| Hospital Charge Code |
761T1124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$325.44 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$264.42
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$281.37
|
| Rate for Payer: First Health Commercial |
$322.05
|
| Rate for Payer: Humana Commercial |
$288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$298.32
|
| Rate for Payer: Ohio Health Group HMO |
$254.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.09
|
| Rate for Payer: PHCS Commercial |
$325.44
|
| Rate for Payer: United Healthcare All Payer |
$298.32
|
|
|
REMOVE NERVE LESION
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,136.53
|
| Rate for Payer: Anthem Medicaid |
$452.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,037.15
|
| Rate for Payer: Healthspan PPO |
$887.37
|
| Rate for Payer: Humana Medicaid |
$452.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$930.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.23
|
| Rate for Payer: Molina Healthcare Passport |
$452.19
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.71
|
|
|
REMOVE NERVE LESION
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REMOVE NERVE LESION
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
76102369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$2,337.51 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,337.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,254.03
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REMOVE NERVE LESION(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 64784
|
| Hospital Charge Code |
761P2369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,136.53
|
| Rate for Payer: Anthem Medicaid |
$452.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,037.15
|
| Rate for Payer: Healthspan PPO |
$887.37
|
| Rate for Payer: Humana Medicaid |
$452.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$930.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.23
|
| Rate for Payer: Molina Healthcare Passport |
$452.19
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.71
|
|
