|
REMOV FOREIGN BODY EXT AUDITOR
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761P2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$80.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.26
|
| Rate for Payer: Anthem Medicaid |
$29.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$174.85
|
| Rate for Payer: Healthspan PPO |
$147.20
|
| Rate for Payer: Humana Medicaid |
$29.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.78
|
| Rate for Payer: Molina Healthcare Passport |
$29.20
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$27.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.49
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$345.73
|
| Rate for Payer: Anthem Medicaid |
$154.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$372.67
|
| Rate for Payer: First Health Commercial |
$426.55
|
| Rate for Payer: Humana Commercial |
$381.65
|
| Rate for Payer: Humana KY Medicaid |
$154.41
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$155.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.12
|
| Rate for Payer: Ohio Health Group HMO |
$336.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.19
|
| Rate for Payer: PHCS Commercial |
$431.04
|
| Rate for Payer: United Healthcare All Payer |
$395.12
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.37 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$345.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.22
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$372.67
|
| Rate for Payer: First Health Commercial |
$426.55
|
| Rate for Payer: Humana Commercial |
$381.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$395.12
|
| Rate for Payer: Ohio Health Group HMO |
$336.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.19
|
| Rate for Payer: PHCS Commercial |
$431.04
|
| Rate for Payer: United Healthcare All Payer |
$395.12
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
45000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
45000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$60.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$60.53
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$61.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.56
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
REMOV FOREIGN BODY(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761P2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Anthem Medicaid |
$65.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Healthspan PPO |
$128.06
|
| Rate for Payer: Humana Medicaid |
$65.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.42
|
| Rate for Payer: Molina Healthcare Passport |
$65.12
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.77
|
|
|
REMOV FOREIGN BODY(T
|
Facility
|
IP
|
$3,280.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761T2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.80
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
REMOV FOREIGN BODY(T
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761T2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem Medicaid |
$1,127.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Humana KY Medicaid |
$1,127.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,139.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,150.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.80
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
IP
|
$1,053.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.89 |
| Max. Negotiated Rate |
$1,010.88 |
| Rate for Payer: Aetna Commercial |
$810.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$821.34
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$873.99
|
| Rate for Payer: First Health Commercial |
$1,000.35
|
| Rate for Payer: Humana Commercial |
$895.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$863.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$926.64
|
| Rate for Payer: Ohio Health Group HMO |
$789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.43
|
| Rate for Payer: PHCS Commercial |
$1,010.88
|
| Rate for Payer: United Healthcare All Payer |
$926.64
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761P1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.37 |
| Max. Negotiated Rate |
$429.61 |
| Rate for Payer: Aetna Commercial |
$324.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.37
|
| Rate for Payer: Anthem Medicaid |
$151.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$429.61
|
| Rate for Payer: Healthspan PPO |
$372.83
|
| Rate for Payer: Humana Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.85
|
| Rate for Payer: Molina Healthcare Passport |
$151.81
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.00
|
| Rate for Payer: UHCCP Medicaid |
$155.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.33
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761T1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.37 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$324.89
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.37
|
| Rate for Payer: Anthem Medicaid |
$151.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,053.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$429.61
|
| Rate for Payer: Healthspan PPO |
$372.83
|
| Rate for Payer: Humana Medicaid |
$151.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$285.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.85
|
| Rate for Payer: Molina Healthcare Passport |
$151.81
|
| Rate for Payer: Multiplan PHCS |
$631.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$737.10
|
| Rate for Payer: UHCCP Medicaid |
$155.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$153.33
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
OP
|
$1,053.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.89 |
| Max. Negotiated Rate |
$1,010.88 |
| Rate for Payer: Aetna Commercial |
$810.81
|
| Rate for Payer: Anthem Medicaid |
$362.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$821.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna Commercial |
$873.99
|
| Rate for Payer: First Health Commercial |
$1,000.35
|
| Rate for Payer: Humana Commercial |
$895.05
|
| Rate for Payer: Humana KY Medicaid |
$362.13
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$365.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$863.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$369.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$926.64
|
| Rate for Payer: Ohio Health Group HMO |
$789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$326.43
|
| Rate for Payer: PHCS Commercial |
$1,010.88
|
| Rate for Payer: United Healthcare All Payer |
$926.64
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761T1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REMOV OF IMPLAN W/CAPSULECTOMY
|
Professional
|
Both
|
$625.00
|
|
| Hospital Charge Code |
22200378
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$625.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
|
|
REMOV OF IMP W/O CAPSULECT -80
|
Professional
|
Both
|
$375.00
|
|
| Hospital Charge Code |
22200377
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$131.25 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.50
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761T0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761T0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
761P0038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.46
|
| Rate for Payer: Anthem Medicaid |
$10.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$25.30
|
| Rate for Payer: Healthspan PPO |
$21.38
|
| Rate for Payer: Humana Medicaid |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.61
|
| Rate for Payer: Molina Healthcare Passport |
$10.40
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$10.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.50
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$10.46
|
| Rate for Payer: Anthem Medicaid |
$10.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$194.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$25.30
|
| Rate for Payer: Healthspan PPO |
$21.38
|
| Rate for Payer: Humana Medicaid |
$10.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.61
|
| Rate for Payer: Molina Healthcare Passport |
$10.40
|
| Rate for Payer: Multiplan PHCS |
$116.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.80
|
| Rate for Payer: UHCCP Medicaid |
$10.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.50
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem Medicaid |
$66.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Humana KY Medicaid |
$66.72
|
| Rate for Payer: Kentucky WC Medicaid |
$67.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
REMOV SKIN TAGS ADDL 10 LESION
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 11201
|
| Hospital Charge Code |
76100038
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna Commercial |
$149.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.32
|
| Rate for Payer: Cash Price |
$97.00
|
| Rate for Payer: Cigna Commercial |
$161.02
|
| Rate for Payer: First Health Commercial |
$184.30
|
| Rate for Payer: Humana Commercial |
$164.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.72
|
| Rate for Payer: Ohio Health Group HMO |
$145.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$60.14
|
| Rate for Payer: PHCS Commercial |
$186.24
|
| Rate for Payer: United Healthcare All Payer |
$170.72
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
45000029
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761T0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
REMOV SKIN TAGS INCLUDETO 15
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
761T0037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
