REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$4,264.00
|
|
Service Code
|
HCPCS 15935
|
Hospital Charge Code |
761T0233
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$554.32 |
Max. Negotiated Rate |
$4,093.44 |
Rate for Payer: Aetna Commercial |
$3,283.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
Rate for Payer: Cash Price |
$2,132.00
|
Rate for Payer: Cigna Commercial |
$3,539.12
|
Rate for Payer: First Health Commercial |
$4,050.80
|
Rate for Payer: Humana Commercial |
$3,624.40
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.20
|
Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$852.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$554.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.84
|
Rate for Payer: PHCS Commercial |
$4,093.44
|
Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$7,190.00
|
|
Service Code
|
HCPCS 15934
|
Hospital Charge Code |
761T0232
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$934.70 |
Max. Negotiated Rate |
$6,902.40 |
Rate for Payer: Aetna Commercial |
$5,536.30
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,608.20
|
Rate for Payer: Cash Price |
$3,595.00
|
Rate for Payer: Cigna Commercial |
$5,967.70
|
Rate for Payer: First Health Commercial |
$6,830.50
|
Rate for Payer: Humana Commercial |
$6,111.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.80
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,306.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,157.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,327.20
|
Rate for Payer: Ohio Health Group HMO |
$5,392.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,438.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$934.70
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.90
|
Rate for Payer: PHCS Commercial |
$6,902.40
|
Rate for Payer: United Healthcare All Payer |
$6,327.20
|
|
REMOVE SACRUM PRESSURE SORE(T
|
Facility
|
IP
|
$5,251.87
|
|
Service Code
|
HCPCS 15931
|
Hospital Charge Code |
761T0231
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$682.74 |
Max. Negotiated Rate |
$5,041.80 |
Rate for Payer: Aetna Commercial |
$4,043.94
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.46
|
Rate for Payer: Cash Price |
$2,625.94
|
Rate for Payer: Cigna Commercial |
$4,359.05
|
Rate for Payer: First Health Commercial |
$4,989.28
|
Rate for Payer: Humana Commercial |
$4,464.09
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.88
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.56
|
Rate for Payer: Ohio Health Choice Commercial |
$4,621.65
|
Rate for Payer: Ohio Health Group HMO |
$3,938.90
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,050.37
|
Rate for Payer: Ohio Health Group PPO No Differential |
$682.74
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.08
|
Rate for Payer: PHCS Commercial |
$5,041.80
|
Rate for Payer: United Healthcare All Payer |
$4,621.65
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$530.00
|
|
Service Code
|
HCPCS 54415
|
Hospital Charge Code |
76102824
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$68.90 |
Max. Negotiated Rate |
$4,220.54 |
Rate for Payer: Aetna Commercial |
$408.10
|
Rate for Payer: Anthem Medicaid |
$182.27
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
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 |
$265.00
|
Rate for Payer: Cash Price |
$265.00
|
Rate for Payer: Cigna Commercial |
$439.90
|
Rate for Payer: First Health Commercial |
$503.50
|
Rate for Payer: Humana Commercial |
$450.50
|
Rate for Payer: Humana KY Medicaid |
$182.27
|
Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
Rate for Payer: Kentucky WC Medicaid |
$184.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
Rate for Payer: Ohio Health Group HMO |
$397.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
Rate for Payer: PHCS Commercial |
$508.80
|
Rate for Payer: United Healthcare All Payer |
$466.40
|
|
REMOVE SELF-CONTD PENIS PROS
|
Professional
|
Both
|
$530.00
|
|
Service Code
|
HCPCS 54415
|
Hospital Charge Code |
76102824
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$185.50 |
Max. Negotiated Rate |
$853.65 |
Rate for Payer: Aetna Commercial |
$853.65
|
Rate for Payer: Anthem Medicaid |
$387.83
|
Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
Rate for Payer: Cash Price |
$265.00
|
Rate for Payer: Cash Price |
$265.00
|
Rate for Payer: Cigna Commercial |
$755.03
|
Rate for Payer: Healthspan PPO |
$826.55
|
Rate for Payer: Humana Medicaid |
$387.83
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.86
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$395.59
|
Rate for Payer: Molina Healthcare Passport |
$387.83
|
Rate for Payer: Multiplan PHCS |
$318.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
Rate for Payer: UHCCP Medicaid |
$185.50
|
Rate for Payer: Wellcare CHIP/Medicaid |
$391.71
|
|
REMOVE SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$530.00
|
|
Service Code
|
HCPCS 54415
|
Hospital Charge Code |
76102824
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$68.90 |
Max. Negotiated Rate |
$508.80 |
Rate for Payer: Aetna Commercial |
$408.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
Rate for Payer: Cash Price |
$265.00
|
Rate for Payer: Cigna Commercial |
$439.90
|
Rate for Payer: First Health Commercial |
$503.50
|
Rate for Payer: Humana Commercial |
$450.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
Rate for Payer: Ohio Health Group HMO |
$397.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
Rate for Payer: PHCS Commercial |
$508.80
|
Rate for Payer: United Healthcare All Payer |
$466.40
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
IP
|
$1,159.00
|
|
Service Code
|
HCPCS 23130
|
Hospital Charge Code |
76100447
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$150.67 |
Max. Negotiated Rate |
$1,112.64 |
Rate for Payer: Aetna Commercial |
$892.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$904.02
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cigna Commercial |
$961.97
|
Rate for Payer: First Health Commercial |
$1,101.05
|
Rate for Payer: Humana Commercial |
$985.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$950.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$347.70
|
Rate for Payer: Ohio Health Choice Commercial |
$1,019.92
|
Rate for Payer: Ohio Health Group HMO |
$869.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$231.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$150.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.29
|
Rate for Payer: PHCS Commercial |
$1,112.64
|
Rate for Payer: United Healthcare All Payer |
$1,019.92
|
|
REMOVE SHOULDER BONE PART
|
Facility
|
OP
|
$1,159.00
|
|
Service Code
|
HCPCS 23130
|
Hospital Charge Code |
76100447
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$150.67 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$892.43
|
Rate for Payer: Anthem Medicaid |
$398.58
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$904.02
|
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 |
$579.50
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cigna Commercial |
$961.97
|
Rate for Payer: First Health Commercial |
$1,101.05
|
Rate for Payer: Humana Commercial |
$985.15
|
Rate for Payer: Humana KY Medicaid |
$398.58
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$402.64
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$950.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$406.58
|
Rate for Payer: Ohio Health Choice Commercial |
$1,019.92
|
Rate for Payer: Ohio Health Group HMO |
$869.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$231.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$150.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.29
|
Rate for Payer: PHCS Commercial |
$1,112.64
|
Rate for Payer: United Healthcare All Payer |
$1,019.92
|
|
REMOVE SHOULDER BONE PART
|
Professional
|
Both
|
$1,159.00
|
|
Service Code
|
HCPCS 23130
|
Hospital Charge Code |
76100447
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$405.65 |
Max. Negotiated Rate |
$1,159.00 |
Rate for Payer: Aetna Commercial |
$878.21
|
Rate for Payer: Anthem Medicaid |
$425.13
|
Rate for Payer: Buckeye Medicare Advantage |
$1,159.00
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cigna Commercial |
$970.00
|
Rate for Payer: Healthspan PPO |
$795.47
|
Rate for Payer: Humana Medicaid |
$425.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$747.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$433.63
|
Rate for Payer: Molina Healthcare Passport |
$425.13
|
Rate for Payer: Multiplan PHCS |
$695.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$811.30
|
Rate for Payer: UHCCP Medicaid |
$405.65
|
Rate for Payer: Wellcare CHIP/Medicaid |
$429.38
|
|
REMOVE SHOULDER BONE PART(P
|
Professional
|
Both
|
$1,159.00
|
|
Service Code
|
HCPCS 23130
|
Hospital Charge Code |
761P0447
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$405.65 |
Max. Negotiated Rate |
$1,159.00 |
Rate for Payer: Aetna Commercial |
$878.21
|
Rate for Payer: Anthem Medicaid |
$425.13
|
Rate for Payer: Buckeye Medicare Advantage |
$1,159.00
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cash Price |
$579.50
|
Rate for Payer: Cigna Commercial |
$970.00
|
Rate for Payer: Healthspan PPO |
$795.47
|
Rate for Payer: Humana Medicaid |
$425.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$747.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$433.63
|
Rate for Payer: Molina Healthcare Passport |
$425.13
|
Rate for Payer: Multiplan PHCS |
$695.40
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$811.30
|
Rate for Payer: UHCCP Medicaid |
$405.65
|
Rate for Payer: Wellcare CHIP/Medicaid |
$429.38
|
|
REMOVE SHOULDER FB DEEP
|
Facility
|
IP
|
$660.00
|
|
Service Code
|
HCPCS 23333
|
Hospital Charge Code |
76100452
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$85.80 |
Max. Negotiated Rate |
$633.60 |
Rate for Payer: Aetna Commercial |
$508.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cigna Commercial |
$547.80
|
Rate for Payer: First Health Commercial |
$627.00
|
Rate for Payer: Humana Commercial |
$561.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
Rate for Payer: Ohio Health Group HMO |
$495.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
Rate for Payer: PHCS Commercial |
$633.60
|
Rate for Payer: United Healthcare All Payer |
$580.80
|
|
REMOVE SHOULDER FB DEEP
|
Facility
|
OP
|
$660.00
|
|
Service Code
|
HCPCS 23333
|
Hospital Charge Code |
76100452
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$85.80 |
Max. Negotiated Rate |
$3,440.07 |
Rate for Payer: Aetna Commercial |
$508.20
|
Rate for Payer: Anthem Medicaid |
$226.97
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cigna Commercial |
$547.80
|
Rate for Payer: First Health Commercial |
$627.00
|
Rate for Payer: Humana Commercial |
$561.00
|
Rate for Payer: Humana KY Medicaid |
$226.97
|
Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
Rate for Payer: Kentucky WC Medicaid |
$229.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
Rate for Payer: Ohio Health Group HMO |
$495.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$85.80
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$204.60
|
Rate for Payer: PHCS Commercial |
$633.60
|
Rate for Payer: United Healthcare All Payer |
$580.80
|
|
REMOVE SHOULDER FB DEEP
|
Professional
|
Both
|
$660.00
|
|
Service Code
|
HCPCS 23333
|
Hospital Charge Code |
76100452
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$231.00 |
Max. Negotiated Rate |
$842.01 |
Rate for Payer: Anthem Medicaid |
$356.13
|
Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cigna Commercial |
$842.01
|
Rate for Payer: Healthspan PPO |
$659.03
|
Rate for Payer: Humana Medicaid |
$356.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.07
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.25
|
Rate for Payer: Molina Healthcare Passport |
$356.13
|
Rate for Payer: Multiplan PHCS |
$396.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
Rate for Payer: UHCCP Medicaid |
$231.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$359.69
|
|
REMOVE SHOULDER FB DEEP(P
|
Professional
|
Both
|
$660.00
|
|
Service Code
|
HCPCS 23333
|
Hospital Charge Code |
761P0452
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$231.00 |
Max. Negotiated Rate |
$842.01 |
Rate for Payer: Anthem Medicaid |
$356.13
|
Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cash Price |
$330.00
|
Rate for Payer: Cigna Commercial |
$842.01
|
Rate for Payer: Healthspan PPO |
$659.03
|
Rate for Payer: Humana Medicaid |
$356.13
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.07
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.25
|
Rate for Payer: Molina Healthcare Passport |
$356.13
|
Rate for Payer: Multiplan PHCS |
$396.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
Rate for Payer: UHCCP Medicaid |
$231.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$359.69
|
|
REMOVE SHOULDER JOINT LINING
|
Professional
|
Both
|
$1,500.00
|
|
Service Code
|
HCPCS 23105
|
Hospital Charge Code |
76100442
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$525.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Aetna Commercial |
$931.56
|
Rate for Payer: Anthem Medicaid |
$534.96
|
Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cigna Commercial |
$1,021.73
|
Rate for Payer: Healthspan PPO |
$843.80
|
Rate for Payer: Humana Medicaid |
$534.96
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.66
|
Rate for Payer: Molina Healthcare Passport |
$534.96
|
Rate for Payer: Multiplan PHCS |
$900.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
Rate for Payer: UHCCP Medicaid |
$525.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$540.31
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
IP
|
$1,500.00
|
|
Service Code
|
HCPCS 23105
|
Hospital Charge Code |
76100442
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$195.00 |
Max. Negotiated Rate |
$1,440.00 |
Rate for Payer: Aetna Commercial |
$1,155.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cigna Commercial |
$1,245.00
|
Rate for Payer: First Health Commercial |
$1,425.00
|
Rate for Payer: Humana Commercial |
$1,275.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
Rate for Payer: PHCS Commercial |
$1,440.00
|
Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
OP
|
$1,500.00
|
|
Service Code
|
HCPCS 23105
|
Hospital Charge Code |
76100442
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$195.00 |
Max. Negotiated Rate |
$8,661.10 |
Rate for Payer: Aetna Commercial |
$1,155.00
|
Rate for Payer: Anthem Medicaid |
$515.85
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cigna Commercial |
$1,245.00
|
Rate for Payer: First Health Commercial |
$1,425.00
|
Rate for Payer: Humana Commercial |
$1,275.00
|
Rate for Payer: Humana KY Medicaid |
$515.85
|
Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
Rate for Payer: Kentucky WC Medicaid |
$521.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
Rate for Payer: PHCS Commercial |
$1,440.00
|
Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
REMOVE SHOULDER JOINT LININ(P
|
Professional
|
Both
|
$1,500.00
|
|
Service Code
|
HCPCS 23105
|
Hospital Charge Code |
761P0442
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$525.00 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Aetna Commercial |
$931.56
|
Rate for Payer: Anthem Medicaid |
$534.96
|
Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cigna Commercial |
$1,021.73
|
Rate for Payer: Healthspan PPO |
$843.80
|
Rate for Payer: Humana Medicaid |
$534.96
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.34
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.66
|
Rate for Payer: Molina Healthcare Passport |
$534.96
|
Rate for Payer: Multiplan PHCS |
$900.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
Rate for Payer: UHCCP Medicaid |
$525.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$540.31
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
OP
|
$925.00
|
|
Service Code
|
HCPCS 64774
|
Hospital Charge Code |
76102368
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$120.25 |
Max. Negotiated Rate |
$2,337.51 |
Rate for Payer: Aetna Commercial |
$712.25
|
Rate for Payer: Anthem Medicaid |
$318.11
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
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 |
$462.50
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cigna Commercial |
$767.75
|
Rate for Payer: First Health Commercial |
$878.75
|
Rate for Payer: Humana Commercial |
$786.25
|
Rate for Payer: Humana KY Medicaid |
$318.11
|
Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
Rate for Payer: Kentucky WC Medicaid |
$321.34
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
Rate for Payer: Ohio Health Group HMO |
$693.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
Rate for Payer: PHCS Commercial |
$888.00
|
Rate for Payer: United Healthcare All Payer |
$814.00
|
|
REMOVE SKIN NERVE LESION
|
Professional
|
Both
|
$925.00
|
|
Service Code
|
HCPCS 64774
|
Hospital Charge Code |
76102368
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$227.04 |
Max. Negotiated Rate |
$925.00 |
Rate for Payer: Aetna Commercial |
$642.40
|
Rate for Payer: Anthem Medicaid |
$227.04
|
Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cigna Commercial |
$582.48
|
Rate for Payer: Healthspan PPO |
$501.57
|
Rate for Payer: Humana Medicaid |
$227.04
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.28
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.58
|
Rate for Payer: Molina Healthcare Passport |
$227.04
|
Rate for Payer: Multiplan PHCS |
$555.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
Rate for Payer: UHCCP Medicaid |
$323.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$229.31
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
IP
|
$925.00
|
|
Service Code
|
HCPCS 64774
|
Hospital Charge Code |
76102368
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$120.25 |
Max. Negotiated Rate |
$888.00 |
Rate for Payer: Aetna Commercial |
$712.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cigna Commercial |
$767.75
|
Rate for Payer: First Health Commercial |
$878.75
|
Rate for Payer: Humana Commercial |
$786.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
Rate for Payer: Ohio Health Group HMO |
$693.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
Rate for Payer: PHCS Commercial |
$888.00
|
Rate for Payer: United Healthcare All Payer |
$814.00
|
|
REMOVE SKIN NERVE LESION(P
|
Professional
|
Both
|
$925.00
|
|
Service Code
|
HCPCS 64774
|
Hospital Charge Code |
761P2368
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$227.04 |
Max. Negotiated Rate |
$925.00 |
Rate for Payer: Aetna Commercial |
$642.40
|
Rate for Payer: Anthem Medicaid |
$227.04
|
Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cash Price |
$462.50
|
Rate for Payer: Cigna Commercial |
$582.48
|
Rate for Payer: Healthspan PPO |
$501.57
|
Rate for Payer: Humana Medicaid |
$227.04
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.28
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.58
|
Rate for Payer: Molina Healthcare Passport |
$227.04
|
Rate for Payer: Multiplan PHCS |
$555.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
Rate for Payer: UHCCP Medicaid |
$323.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$229.31
|
|
REMOVE SPINE ELTRD PERQ ARA(P
|
Professional
|
Both
|
$1,400.00
|
|
Service Code
|
HCPCS 63661
|
Hospital Charge Code |
761P2306
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$167.67 |
Max. Negotiated Rate |
$1,400.00 |
Rate for Payer: Aetna Commercial |
$500.01
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.67
|
Rate for Payer: Anthem Medicaid |
$227.64
|
Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: Cigna Commercial |
$873.41
|
Rate for Payer: Healthspan PPO |
$539.49
|
Rate for Payer: Humana Medicaid |
$227.64
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.92
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.19
|
Rate for Payer: Molina Healthcare Passport |
$227.64
|
Rate for Payer: Multiplan PHCS |
$840.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
Rate for Payer: UHCCP Medicaid |
$176.05
|
Rate for Payer: Wellcare CHIP/Medicaid |
$229.92
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Facility
|
OP
|
$1,400.00
|
|
Service Code
|
HCPCS 63661
|
Hospital Charge Code |
76102306
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$182.00 |
Max. Negotiated Rate |
$2,337.51 |
Rate for Payer: Aetna Commercial |
$1,078.00
|
Rate for Payer: Anthem Medicaid |
$481.46
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,669.65
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
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 |
$700.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: Cigna Commercial |
$1,162.00
|
Rate for Payer: First Health Commercial |
$1,330.00
|
Rate for Payer: Humana Commercial |
$1,190.00
|
Rate for Payer: Humana KY Medicaid |
$481.46
|
Rate for Payer: Humana Medicare Advantage |
$1,669.65
|
Rate for Payer: Kentucky WC Medicaid |
$486.36
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.58
|
Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
Rate for Payer: PHCS Commercial |
$1,344.00
|
Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Professional
|
Both
|
$1,400.00
|
|
Service Code
|
HCPCS 63661
|
Hospital Charge Code |
76102306
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$167.67 |
Max. Negotiated Rate |
$1,400.00 |
Rate for Payer: Aetna Commercial |
$500.01
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.67
|
Rate for Payer: Anthem Medicaid |
$227.64
|
Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: Cash Price |
$700.00
|
Rate for Payer: Cigna Commercial |
$873.41
|
Rate for Payer: Healthspan PPO |
$539.49
|
Rate for Payer: Humana Medicaid |
$227.64
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.92
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$232.19
|
Rate for Payer: Molina Healthcare Passport |
$227.64
|
Rate for Payer: Multiplan PHCS |
$840.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
Rate for Payer: UHCCP Medicaid |
$176.05
|
Rate for Payer: Wellcare CHIP/Medicaid |
$229.92
|
|