|
REMOVE SPINE ELTRD PERQ ARAY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
76102306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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: 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 |
$420.00
|
| 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 PLATE
|
Professional
|
Both
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.42 |
| Max. Negotiated Rate |
$10,421.00 |
| Rate for Payer: Aetna Commercial |
$1,166.70
|
| Rate for Payer: Anthem Medicaid |
$514.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$10,421.00
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Healthspan PPO |
$717.13
|
| Rate for Payer: Humana Medicaid |
$514.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$915.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.71
|
| Rate for Payer: Molina Healthcare Passport |
$514.42
|
| Rate for Payer: Multiplan PHCS |
$6,252.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,294.70
|
| Rate for Payer: UHCCP Medicaid |
$3,647.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.56
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
IP
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,354.73 |
| Max. Negotiated Rate |
$10,004.16 |
| Rate for Payer: Aetna Commercial |
$8,024.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,128.38
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$8,649.43
|
| Rate for Payer: First Health Commercial |
$9,899.95
|
| Rate for Payer: Humana Commercial |
$8,857.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,545.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,690.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,170.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,815.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,354.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.51
|
| Rate for Payer: PHCS Commercial |
$10,004.16
|
| Rate for Payer: United Healthcare All Payer |
$9,170.48
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
OP
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,354.73 |
| Max. Negotiated Rate |
$10,004.16 |
| Rate for Payer: Aetna Commercial |
$8,024.17
|
| Rate for Payer: Anthem Medicaid |
$3,583.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,942.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,128.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,119.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,972.17
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$8,649.43
|
| Rate for Payer: First Health Commercial |
$9,899.95
|
| Rate for Payer: Humana Commercial |
$8,857.85
|
| Rate for Payer: Humana KY Medicaid |
$3,583.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,942.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,620.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,545.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,690.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,655.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,170.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,815.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,084.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,354.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.51
|
| Rate for Payer: PHCS Commercial |
$10,004.16
|
| Rate for Payer: United Healthcare All Payer |
$9,170.48
|
|
|
REMOVE SPINE ELTRD PLATE (P
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761P2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.42 |
| Max. Negotiated Rate |
$2,063.00 |
| Rate for Payer: Aetna Commercial |
$1,166.70
|
| Rate for Payer: Anthem Medicaid |
$514.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,063.00
|
| Rate for Payer: Cash Price |
$1,031.50
|
| Rate for Payer: Cash Price |
$1,031.50
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Healthspan PPO |
$717.13
|
| Rate for Payer: Humana Medicaid |
$514.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$915.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.71
|
| Rate for Payer: Molina Healthcare Passport |
$514.42
|
| Rate for Payer: Multiplan PHCS |
$1,237.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,444.10
|
| Rate for Payer: UHCCP Medicaid |
$722.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.56
|
|
|
REMOVE SPINE ELTRD PLATE (T
|
Facility
|
OP
|
$8,358.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761T2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,086.54 |
| Max. Negotiated Rate |
$8,023.68 |
| Rate for Payer: Aetna Commercial |
$6,435.66
|
| Rate for Payer: Anthem Medicaid |
$2,874.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,942.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,119.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,972.17
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cigna Commercial |
$6,937.14
|
| Rate for Payer: First Health Commercial |
$7,940.10
|
| Rate for Payer: Humana Commercial |
$7,104.30
|
| Rate for Payer: Humana KY Medicaid |
$2,874.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,942.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.98
|
| Rate for Payer: PHCS Commercial |
$8,023.68
|
| Rate for Payer: United Healthcare All Payer |
$7,355.04
|
|
|
REMOVE SPINE ELTRD PLATE (T
|
Facility
|
IP
|
$8,358.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761T2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,086.54 |
| Max. Negotiated Rate |
$8,023.68 |
| Rate for Payer: Aetna Commercial |
$6,435.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.24
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cigna Commercial |
$6,937.14
|
| Rate for Payer: First Health Commercial |
$7,940.10
|
| Rate for Payer: Humana Commercial |
$7,104.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.98
|
| Rate for Payer: PHCS Commercial |
$8,023.68
|
| Rate for Payer: United Healthcare All Payer |
$7,355.04
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
OP
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.14 |
| Max. Negotiated Rate |
$3,493.92 |
| Rate for Payer: Aetna Commercial |
$2,802.42
|
| Rate for Payer: Anthem Medicaid |
$1,251.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,838.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cigna Commercial |
$3,020.78
|
| Rate for Payer: First Health Commercial |
$3,457.52
|
| Rate for Payer: Humana Commercial |
$3,093.58
|
| Rate for Payer: Humana KY Medicaid |
$1,251.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,264.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,984.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,685.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,276.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,202.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,729.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,128.24
|
| Rate for Payer: PHCS Commercial |
$3,493.92
|
| Rate for Payer: United Healthcare All Payer |
$3,202.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
IP
|
$2,989.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761T0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.64 |
| Max. Negotiated Rate |
$2,869.92 |
| Rate for Payer: Aetna Commercial |
$2,301.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.81
|
| Rate for Payer: Cash Price |
$1,494.75
|
| Rate for Payer: Cigna Commercial |
$2,481.28
|
| Rate for Payer: First Health Commercial |
$2,840.02
|
| Rate for Payer: Humana Commercial |
$2,541.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$896.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$926.74
|
| Rate for Payer: PHCS Commercial |
$2,869.92
|
| Rate for Payer: United Healthcare All Payer |
$2,630.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
OP
|
$2,989.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761T0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.64 |
| Max. Negotiated Rate |
$2,869.92 |
| Rate for Payer: Aetna Commercial |
$2,301.92
|
| Rate for Payer: Anthem Medicaid |
$1,028.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,494.75
|
| Rate for Payer: Cash Price |
$1,494.75
|
| Rate for Payer: Cigna Commercial |
$2,481.28
|
| Rate for Payer: First Health Commercial |
$2,840.02
|
| Rate for Payer: Humana Commercial |
$2,541.08
|
| Rate for Payer: Humana KY Medicaid |
$1,028.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$597.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$926.74
|
| Rate for Payer: PHCS Commercial |
$2,869.92
|
| Rate for Payer: United Healthcare All Payer |
$2,630.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
IP
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.14 |
| Max. Negotiated Rate |
$3,493.92 |
| Rate for Payer: Aetna Commercial |
$2,802.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,838.81
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cigna Commercial |
$3,020.78
|
| Rate for Payer: First Health Commercial |
$3,457.52
|
| Rate for Payer: Humana Commercial |
$3,093.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,984.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,685.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,091.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,202.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,729.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,128.24
|
| Rate for Payer: PHCS Commercial |
$3,493.92
|
| Rate for Payer: United Healthcare All Payer |
$3,202.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Professional
|
Both
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$3,639.50 |
| Rate for Payer: Aetna Commercial |
$67.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.05
|
| Rate for Payer: Anthem Medicaid |
$29.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,639.50
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cigna Commercial |
$136.54
|
| Rate for Payer: Healthspan PPO |
$102.60
|
| Rate for Payer: Humana Medicaid |
$29.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.59
|
| Rate for Payer: Molina Healthcare Passport |
$29.99
|
| Rate for Payer: Multiplan PHCS |
$2,183.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,547.65
|
| Rate for Payer: UHCCP Medicaid |
$35.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.29
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761P0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$67.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.05
|
| Rate for Payer: Anthem Medicaid |
$29.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$136.54
|
| Rate for Payer: Healthspan PPO |
$102.60
|
| Rate for Payer: Humana Medicaid |
$29.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.59
|
| Rate for Payer: Molina Healthcare Passport |
$29.99
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$35.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.29
|
|
|
REMOVE THYROID DUCT LESION
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.26 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$633.38
|
| Rate for Payer: Anthem Medicaid |
$380.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,440.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$601.57
|
| Rate for Payer: Healthspan PPO |
$534.14
|
| Rate for Payer: Humana Medicaid |
$380.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$564.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.87
|
| Rate for Payer: Molina Healthcare Passport |
$380.26
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,008.00
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.06
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem Medicaid |
$495.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Humana KY Medicaid |
$495.22
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$500.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$446.40
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
REMOVE THYROID DUCT LESION(P
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
761P2279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.26 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$633.38
|
| Rate for Payer: Anthem Medicaid |
$380.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,440.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$601.57
|
| Rate for Payer: Healthspan PPO |
$534.14
|
| Rate for Payer: Humana Medicaid |
$380.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$564.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.87
|
| Rate for Payer: Molina Healthcare Passport |
$380.26
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,008.00
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.06
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: Anthem Medicaid |
$125.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$402.16
|
| Rate for Payer: Healthspan PPO |
$495.49
|
| Rate for Payer: Humana Medicaid |
$125.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.44
|
| Rate for Payer: Molina Healthcare Passport |
$125.92
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.18
|
|
|
REMOVE TISSUE EXPANDER(S)(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
761P0114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: Anthem Medicaid |
$125.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$402.16
|
| Rate for Payer: Healthspan PPO |
$495.49
|
| Rate for Payer: Humana Medicaid |
$125.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.44
|
| Rate for Payer: Molina Healthcare Passport |
$125.92
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.18
|
|
|
REMOVE/TRANSPLANT TENDON
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$1,129.38
|
| Rate for Payer: Anthem Medicaid |
$516.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,242.35
|
| Rate for Payer: Healthspan PPO |
$1,022.98
|
| Rate for Payer: Humana Medicaid |
$516.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.86
|
| Rate for Payer: Molina Healthcare Passport |
$516.53
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.70
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| 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 |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$616.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
REMOVE/TRANSPLANT TENDON(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
761P0461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$1,129.38
|
| Rate for Payer: Anthem Medicaid |
$516.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,242.35
|
| Rate for Payer: Healthspan PPO |
$1,022.98
|
| Rate for Payer: Humana Medicaid |
$516.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.86
|
| Rate for Payer: Molina Healthcare Passport |
$516.53
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.70
|
|
