|
REMOVE PALATE/LESION
|
Facility
|
IP
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.61 |
| Max. Negotiated Rate |
$8,829.12 |
| Rate for Payer: Aetna Commercial |
$7,081.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.66
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$7,633.51
|
| Rate for Payer: First Health Commercial |
$8,737.15
|
| Rate for Payer: Humana Commercial |
$7,817.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,759.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,093.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,839.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.07
|
| Rate for Payer: PHCS Commercial |
$8,829.12
|
| Rate for Payer: United Healthcare All Payer |
$8,093.36
|
|
|
REMOVE PALATE/LESION
|
Facility
|
OP
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,195.61 |
| Max. Negotiated Rate |
$8,829.12 |
| Rate for Payer: Aetna Commercial |
$7,081.69
|
| Rate for Payer: Anthem Medicaid |
$3,162.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,173.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$7,633.51
|
| Rate for Payer: First Health Commercial |
$8,737.15
|
| Rate for Payer: Humana Commercial |
$7,817.45
|
| Rate for Payer: Humana KY Medicaid |
$3,162.85
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,195.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,541.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,787.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,226.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,093.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,839.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.07
|
| Rate for Payer: PHCS Commercial |
$8,829.12
|
| Rate for Payer: United Healthcare All Payer |
$8,093.36
|
|
|
REMOVE PALATE/LESION
|
Professional
|
Both
|
$9,197.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
76101672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$9,197.00 |
| Rate for Payer: Aetna Commercial |
$1,365.47
|
| Rate for Payer: Anthem Medicaid |
$367.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,197.00
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cash Price |
$4,598.50
|
| Rate for Payer: Cigna Commercial |
$1,330.11
|
| Rate for Payer: Healthspan PPO |
$1,151.52
|
| Rate for Payer: Humana Medicaid |
$367.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,263.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.13
|
| Rate for Payer: Molina Healthcare Passport |
$367.77
|
| Rate for Payer: Multiplan PHCS |
$5,518.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,437.90
|
| Rate for Payer: UHCCP Medicaid |
$3,218.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.45
|
|
|
REMOVE PALATE/LESION(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761P1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,365.47
|
| Rate for Payer: Anthem Medicaid |
$367.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,330.11
|
| Rate for Payer: Healthspan PPO |
$1,151.52
|
| Rate for Payer: Humana Medicaid |
$367.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,263.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.13
|
| Rate for Payer: Molina Healthcare Passport |
$367.77
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$371.45
|
|
|
REMOVE PALATE/LESION(T
|
Facility
|
OP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761T1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem Medicaid |
$2,389.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Humana KY Medicaid |
$2,389.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
REMOVE PALATE/LESION(T
|
Facility
|
IP
|
$6,947.00
|
|
|
Service Code
|
HCPCS 42120
|
| Hospital Charge Code |
761T1672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$903.11 |
| Max. Negotiated Rate |
$6,669.12 |
| Rate for Payer: Aetna Commercial |
$5,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,418.66
|
| Rate for Payer: Cash Price |
$3,473.50
|
| Rate for Payer: Cigna Commercial |
$5,766.01
|
| Rate for Payer: First Health Commercial |
$6,599.65
|
| Rate for Payer: Humana Commercial |
$5,904.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,696.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,126.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,113.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,210.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.57
|
| Rate for Payer: PHCS Commercial |
$6,669.12
|
| Rate for Payer: United Healthcare All Payer |
$6,113.36
|
|
|
REMOVE PELVIS LYMPH NODES
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.15 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$1,269.61
|
| Rate for Payer: Anthem Medicaid |
$810.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,155.08
|
| Rate for Payer: Healthspan PPO |
$1,015.17
|
| Rate for Payer: Humana Medicaid |
$810.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,039.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.35
|
| Rate for Payer: Molina Healthcare Passport |
$810.15
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.25
|
|
|
REMOVE PELVIS LYMPH NODES
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
REMOVE PELVIS LYMPH NODES
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
76101610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
REMOVE PELVIS LYMPH NODES(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 38770
|
| Hospital Charge Code |
761P1610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.15 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$1,269.61
|
| Rate for Payer: Anthem Medicaid |
$810.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,155.08
|
| Rate for Payer: Healthspan PPO |
$1,015.17
|
| Rate for Payer: Humana Medicaid |
$810.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,039.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$826.35
|
| Rate for Payer: Molina Healthcare Passport |
$810.15
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.25
|
|
|
REMOVE PROSTATE REGROWTH
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
REMOVE PROSTATE REGROWTH
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$570.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$370.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
REMOVE PROSTATE REGROWTH
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.43 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Aetna Commercial |
$719.87
|
| Rate for Payer: Anthem Medicaid |
$444.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,850.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$634.71
|
| Rate for Payer: Healthspan PPO |
$575.60
|
| Rate for Payer: Humana Medicaid |
$444.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.32
|
| Rate for Payer: Molina Healthcare Passport |
$444.43
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,995.00
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.87
|
|
|
REMOVE PROSTATE REGROWTH(P
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
761P2114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.43 |
| Max. Negotiated Rate |
$2,850.00 |
| Rate for Payer: Aetna Commercial |
$719.87
|
| Rate for Payer: Anthem Medicaid |
$444.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,850.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$634.71
|
| Rate for Payer: Healthspan PPO |
$575.60
|
| Rate for Payer: Humana Medicaid |
$444.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.32
|
| Rate for Payer: Molina Healthcare Passport |
$444.43
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,995.00
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.87
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,690.00 |
| Rate for Payer: Aetna Commercial |
$718.16
|
| Rate for Payer: Anthem Medicaid |
$340.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,690.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$793.00
|
| Rate for Payer: Healthspan PPO |
$650.50
|
| Rate for Payer: Humana Medicaid |
$340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.89
|
| Rate for Payer: Molina Healthcare Passport |
$340.09
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,183.00
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.49
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$1,622.40 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.90
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem Medicaid |
$581.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| 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 |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Humana KY Medicaid |
$581.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$587.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.90
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
REMOVE RADIUS HEAD IMPLANT(P
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
761P0513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,690.00 |
| Rate for Payer: Aetna Commercial |
$718.16
|
| Rate for Payer: Anthem Medicaid |
$340.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,690.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$793.00
|
| Rate for Payer: Healthspan PPO |
$650.50
|
| Rate for Payer: Humana Medicaid |
$340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.89
|
| Rate for Payer: Molina Healthcare Passport |
$340.09
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,183.00
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.49
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Healthspan PPO |
$361.42
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
REMOVE RECTAL OBSTRUCTION(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
761P1908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Healthspan PPO |
$361.42
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.45 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$1,975.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$2,128.95
|
| Rate for Payer: First Health Commercial |
$2,436.75
|
| Rate for Payer: Humana Commercial |
$2,180.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,103.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,892.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$769.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,257.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$795.15
|
| Rate for Payer: PHCS Commercial |
$2,462.40
|
| Rate for Payer: United Healthcare All Payer |
$2,257.20
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.45 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$1,975.05
|
| Rate for Payer: Anthem Medicaid |
$882.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$590.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,000.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$827.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.47
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$2,128.95
|
| Rate for Payer: First Health Commercial |
$2,436.75
|
| Rate for Payer: Humana Commercial |
$2,180.25
|
| Rate for Payer: Humana KY Medicaid |
$882.10
|
| Rate for Payer: Humana Medicare Advantage |
$590.72
|
| Rate for Payer: Kentucky WC Medicaid |
$891.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,103.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,892.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$899.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,257.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$513.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$333.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$795.15
|
| Rate for Payer: PHCS Commercial |
$2,462.40
|
| Rate for Payer: United Healthcare All Payer |
$2,257.20
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Professional
|
Both
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$2,565.00 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.46
|
| Rate for Payer: Anthem Medicaid |
$43.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,565.00
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$82.26
|
| Rate for Payer: Healthspan PPO |
$405.68
|
| Rate for Payer: Humana Medicaid |
$43.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.77
|
| Rate for Payer: Molina Healthcare Passport |
$43.89
|
| Rate for Payer: Multiplan PHCS |
$1,539.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,795.50
|
| Rate for Payer: UHCCP Medicaid |
$42.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.33
|
|
