|
REMOVE TUMOR - HAND/FINGER
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REMOVE TUMOR - HAND/FINGER
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.89 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$936.27
|
| Rate for Payer: Anthem Medicaid |
$399.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,026.20
|
| Rate for Payer: Healthspan PPO |
$848.06
|
| Rate for Payer: Humana Medicaid |
$399.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.89
|
| Rate for Payer: Molina Healthcare Passport |
$399.89
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.89
|
|
|
REMOVE TUMOR - HAND/FINGER
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REMOVE TUMOR - HAND/FINGER(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
761P0670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.89 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$936.27
|
| Rate for Payer: Anthem Medicaid |
$399.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,026.20
|
| Rate for Payer: Healthspan PPO |
$848.06
|
| Rate for Payer: Humana Medicaid |
$399.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.89
|
| Rate for Payer: Molina Healthcare Passport |
$399.89
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.89
|
|
|
REMOVE TUMOR - LOWER LEG
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| 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 |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
REMOVE TUMOR - LOWER LEG
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.21 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,301.83
|
| Rate for Payer: Anthem Medicaid |
$601.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,459.46
|
| Rate for Payer: Healthspan PPO |
$1,179.18
|
| Rate for Payer: Humana Medicaid |
$601.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,277.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.23
|
| Rate for Payer: Molina Healthcare Passport |
$601.21
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.22
|
|
|
REMOVE TUMOR - LOWER LEG
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
REMOVE TUMOR - LOWER LEG(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
761P0894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.21 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$1,301.83
|
| Rate for Payer: Anthem Medicaid |
$601.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,459.46
|
| Rate for Payer: Healthspan PPO |
$1,179.18
|
| Rate for Payer: Humana Medicaid |
$601.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,277.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.23
|
| Rate for Payer: Molina Healthcare Passport |
$601.21
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.22
|
|
|
REMOVE TUNNELED IP CATH
|
Facility
|
OP
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.08 |
| Max. Negotiated Rate |
$6,831.36 |
| Rate for Payer: Aetna Commercial |
$5,479.32
|
| Rate for Payer: Anthem Medicaid |
$2,447.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,550.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cigna Commercial |
$5,906.28
|
| Rate for Payer: First Health Commercial |
$6,760.20
|
| Rate for Payer: Humana Commercial |
$6,048.60
|
| Rate for Payer: Humana KY Medicaid |
$2,447.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,472.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,835.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,251.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,496.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,262.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,337.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.96
|
| Rate for Payer: PHCS Commercial |
$6,831.36
|
| Rate for Payer: United Healthcare All Payer |
$6,262.08
|
|
|
REMOVE TUNNELED IP CATH
|
Professional
|
Both
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$7,116.00 |
| Rate for Payer: Aetna Commercial |
$568.72
|
| Rate for Payer: Anthem Medicaid |
$302.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,116.00
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cigna Commercial |
$534.92
|
| Rate for Payer: Healthspan PPO |
$479.61
|
| Rate for Payer: Humana Medicaid |
$302.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$491.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.43
|
| Rate for Payer: Molina Healthcare Passport |
$302.38
|
| Rate for Payer: Multiplan PHCS |
$4,269.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,981.20
|
| Rate for Payer: UHCCP Medicaid |
$2,490.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.40
|
|
|
REMOVE TUNNELED IP CATH
|
Facility
|
IP
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.08 |
| Max. Negotiated Rate |
$6,831.36 |
| Rate for Payer: Aetna Commercial |
$5,479.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,550.48
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cigna Commercial |
$5,906.28
|
| Rate for Payer: First Health Commercial |
$6,760.20
|
| Rate for Payer: Humana Commercial |
$6,048.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,835.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,251.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,134.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,262.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,337.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$925.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.96
|
| Rate for Payer: PHCS Commercial |
$6,831.36
|
| Rate for Payer: United Healthcare All Payer |
$6,262.08
|
|
|
REMOVE TUNNELED IP CATH(P
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761P2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$970.00 |
| Rate for Payer: Aetna Commercial |
$568.72
|
| Rate for Payer: Anthem Medicaid |
$302.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$970.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| Rate for Payer: Cigna Commercial |
$534.92
|
| Rate for Payer: Healthspan PPO |
$479.61
|
| Rate for Payer: Humana Medicaid |
$302.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$491.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.43
|
| Rate for Payer: Molina Healthcare Passport |
$302.38
|
| Rate for Payer: Multiplan PHCS |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.00
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.40
|
|
|
REMOVE TUNNELED IP CATH(T
|
Facility
|
IP
|
$6,146.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761T2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.98 |
| Max. Negotiated Rate |
$5,900.16 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,793.88
|
| Rate for Payer: Cash Price |
$3,073.00
|
| Rate for Payer: Cigna Commercial |
$5,101.18
|
| Rate for Payer: First Health Commercial |
$5,838.70
|
| Rate for Payer: Humana Commercial |
$5,224.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,039.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,535.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,843.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,408.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,609.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,229.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,905.26
|
| Rate for Payer: PHCS Commercial |
$5,900.16
|
| Rate for Payer: United Healthcare All Payer |
$5,408.48
|
|
|
REMOVE TUNNELED IP CATH(T
|
Facility
|
OP
|
$6,146.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761T2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$798.98 |
| Max. Negotiated Rate |
$5,900.16 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Anthem Medicaid |
$2,113.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,793.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,073.00
|
| Rate for Payer: Cash Price |
$3,073.00
|
| Rate for Payer: Cigna Commercial |
$5,101.18
|
| Rate for Payer: First Health Commercial |
$5,838.70
|
| Rate for Payer: Humana Commercial |
$5,224.10
|
| Rate for Payer: Humana KY Medicaid |
$2,113.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,039.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,535.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,156.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,408.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,609.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,229.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,905.26
|
| Rate for Payer: PHCS Commercial |
$5,900.16
|
| Rate for Payer: United Healthcare All Payer |
$5,408.48
|
|
|
REMOVE UTERUS AFTER CESAREAN
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 59525
|
| Hospital Charge Code |
76102724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$815.62 |
| Rate for Payer: Aetna Commercial |
$815.62
|
| Rate for Payer: Anthem Medicaid |
$374.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$695.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$751.75
|
| Rate for Payer: Healthspan PPO |
$591.98
|
| Rate for Payer: Humana Medicaid |
$374.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.65
|
| Rate for Payer: Molina Healthcare Passport |
$374.17
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$486.50
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.91
|
|
|
REMOVE VAGINA LESION
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,555.00 |
| Rate for Payer: Anthem Medicaid |
$570.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,555.00
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$570.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$581.40
|
| Rate for Payer: Molina Healthcare Passport |
$570.00
|
| Rate for Payer: Multiplan PHCS |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,788.50
|
| Rate for Payer: UHCCP Medicaid |
$894.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$575.70
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$127.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$127.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$128.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.70
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$239.31
|
| Rate for Payer: Anthem Medicaid |
$37.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Healthspan PPO |
$231.71
|
| Rate for Payer: Humana Medicaid |
$37.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.32
|
| Rate for Payer: Molina Healthcare Passport |
$37.57
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.00
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.95
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
761P2613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$370.00 |
| Rate for Payer: Aetna Commercial |
$239.31
|
| Rate for Payer: Anthem Medicaid |
$37.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Healthspan PPO |
$231.71
|
| Rate for Payer: Humana Medicaid |
$37.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.32
|
| Rate for Payer: Molina Healthcare Passport |
$37.57
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.00
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.95
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.10 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.70
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
REMOVE VENTRICULAR DEVICE
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
REMOVE VENTRICULAR DEVICE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$893.09 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Anthem Medicaid |
$893.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,969.16
|
| Rate for Payer: Healthspan PPO |
$2,023.12
|
| Rate for Payer: Humana Medicaid |
$893.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,688.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$910.95
|
| Rate for Payer: Molina Healthcare Passport |
$893.09
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$902.02
|
|
|
REMOVE VENTRICULAR DEVICE
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
REMOVE VENTRICULAR DEVICE(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
761P1330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$893.09 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Anthem Medicaid |
$893.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,969.16
|
| Rate for Payer: Healthspan PPO |
$2,023.12
|
| Rate for Payer: Humana Medicaid |
$893.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,688.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$910.95
|
| Rate for Payer: Molina Healthcare Passport |
$893.09
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$902.02
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem Medicaid |
$271.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| 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 |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Humana KY Medicaid |
$271.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$274.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.90
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
