|
REMOVAL BILIARY DRG CATH
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REMOVAL BILIARY DRG CATH
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REMOVAL BILIARY DRG CATH
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 47537
|
| Hospital Charge Code |
36001273
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$308.43 |
| Rate for Payer: Ambetter Exchange |
$89.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.86
|
| Rate for Payer: Anthem Medicaid |
$302.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.28
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$166.41
|
| Rate for Payer: Humana Medicaid |
$302.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.43
|
| Rate for Payer: Molina Healthcare Passport |
$302.38
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.22
|
| Rate for Payer: UHCCP Medicaid |
$84.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.40
|
|
|
REMOVAL DUCT BREAST
|
Facility
|
IP
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,618.80 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,618.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,694.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.24
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
|
REMOVAL DUCT BREAST
|
Facility
|
OP
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,855.68 |
| Max. Negotiated Rate |
$5,180.16 |
| Rate for Payer: Aetna Commercial |
$4,154.92
|
| Rate for Payer: Anthem Medicaid |
$1,855.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,208.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$4,478.68
|
| Rate for Payer: First Health Commercial |
$5,126.20
|
| Rate for Payer: Humana Commercial |
$4,586.60
|
| Rate for Payer: Humana KY Medicaid |
$1,855.68
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,874.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,424.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,982.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,892.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,748.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,047.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,694.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.24
|
| Rate for Payer: PHCS Commercial |
$5,180.16
|
| Rate for Payer: United Healthcare All Payer |
$4,748.48
|
|
|
REMOVAL DUCT BREAST
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
76100287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.63 |
| Max. Negotiated Rate |
$3,237.60 |
| Rate for Payer: Aetna Commercial |
$412.69
|
| Rate for Payer: Ambetter Exchange |
$307.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.63
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$307.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$307.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.58
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cash Price |
$2,698.00
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Healthspan PPO |
$463.94
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$3,237.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.30
|
| Rate for Payer: UHCCP Medicaid |
$174.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$307.15
|
|
|
REMOVAL DUCT BREAST(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761P0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.63 |
| Max. Negotiated Rate |
$463.94 |
| Rate for Payer: Aetna Commercial |
$412.69
|
| Rate for Payer: Ambetter Exchange |
$307.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.63
|
| Rate for Payer: Anthem Medicaid |
$174.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$307.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$307.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.58
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Healthspan PPO |
$463.94
|
| Rate for Payer: Humana Medicaid |
$174.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$379.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$307.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.05
|
| Rate for Payer: Molina Healthcare Passport |
$174.56
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.30
|
| Rate for Payer: UHCCP Medicaid |
$174.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$307.15
|
|
|
REMOVAL DUCT BREAST(T
|
Facility
|
OP
|
$4,696.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761T0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,614.95 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,615.92
|
| Rate for Payer: Anthem Medicaid |
$1,614.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cigna Commercial |
$3,897.68
|
| Rate for Payer: First Health Commercial |
$4,461.20
|
| Rate for Payer: Humana Commercial |
$3,991.60
|
| Rate for Payer: Humana KY Medicaid |
$1,614.95
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,756.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,085.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,240.24
|
| Rate for Payer: PHCS Commercial |
$4,508.16
|
| Rate for Payer: United Healthcare All Payer |
$4,132.48
|
|
|
REMOVAL DUCT BREAST(T
|
Facility
|
IP
|
$4,696.00
|
|
|
Service Code
|
HCPCS 19112
|
| Hospital Charge Code |
761T0287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,408.80 |
| Max. Negotiated Rate |
$4,508.16 |
| Rate for Payer: Aetna Commercial |
$3,615.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.88
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cigna Commercial |
$3,897.68
|
| Rate for Payer: First Health Commercial |
$4,461.20
|
| Rate for Payer: Humana Commercial |
$3,991.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,756.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,085.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,240.24
|
| Rate for Payer: PHCS Commercial |
$4,508.16
|
| Rate for Payer: United Healthcare All Payer |
$4,132.48
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.33 |
| Max. Negotiated Rate |
$654.69 |
| Rate for Payer: Aetna Commercial |
$627.67
|
| Rate for Payer: Ambetter Exchange |
$448.55
|
| Rate for Payer: Anthem Medicaid |
$254.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.26
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$654.69
|
| Rate for Payer: Healthspan PPO |
$529.32
|
| Rate for Payer: Humana Medicaid |
$254.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.42
|
| Rate for Payer: Molina Healthcare Passport |
$254.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.12
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.55
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
76101125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Ambetter Exchange |
$190.22
|
| Rate for Payer: Anthem Medicaid |
$103.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.26
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$287.44
|
| Rate for Payer: Healthspan PPO |
$239.15
|
| Rate for Payer: Humana Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.95
|
| Rate for Payer: Molina Healthcare Passport |
$103.87
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.29
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.22
|
|
|
REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
76101126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
REMOVAL FOREIGN BODY HAND
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$458.81 |
| Rate for Payer: Aetna Commercial |
$421.83
|
| Rate for Payer: Ambetter Exchange |
$309.92
|
| Rate for Payer: Anthem Medicaid |
$182.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.90
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$458.81
|
| Rate for Payer: Healthspan PPO |
$382.09
|
| Rate for Payer: Humana Medicaid |
$182.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$371.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.88
|
| Rate for Payer: Molina Healthcare Passport |
$182.24
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.90
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.92
|
|
|
REMOVAL FOREIGN BODY HAND
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVAL FOREIGN BODY HAND
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
76100661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVAL FOREIGN BODY HAND(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26070
|
| Hospital Charge Code |
761P0661
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.24 |
| Max. Negotiated Rate |
$458.81 |
| Rate for Payer: Aetna Commercial |
$421.83
|
| Rate for Payer: Ambetter Exchange |
$309.92
|
| Rate for Payer: Anthem Medicaid |
$182.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.90
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$458.81
|
| Rate for Payer: Healthspan PPO |
$382.09
|
| Rate for Payer: Humana Medicaid |
$182.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$371.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$309.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.88
|
| Rate for Payer: Molina Healthcare Passport |
$182.24
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.90
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.92
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
REMOVAL FOREIGN BODY(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 30310
|
| Hospital Charge Code |
761P1125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Ambetter Exchange |
$190.22
|
| Rate for Payer: Anthem Medicaid |
$103.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.26
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$287.44
|
| Rate for Payer: Healthspan PPO |
$239.15
|
| Rate for Payer: Humana Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.95
|
| Rate for Payer: Molina Healthcare Passport |
$103.87
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.29
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.22
|
|
|
REMOVAL FOREIGN BODY(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 30320
|
| Hospital Charge Code |
761P1126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.33 |
| Max. Negotiated Rate |
$654.69 |
| Rate for Payer: Aetna Commercial |
$627.67
|
| Rate for Payer: Ambetter Exchange |
$448.55
|
| Rate for Payer: Anthem Medicaid |
$254.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.26
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$654.69
|
| Rate for Payer: Healthspan PPO |
$529.32
|
| Rate for Payer: Humana Medicaid |
$254.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.42
|
| Rate for Payer: Molina Healthcare Passport |
$254.33
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.12
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.55
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
45000263
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$436.50 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Aetna Commercial |
$1,120.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,134.90
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$1,207.65
|
| Rate for Payer: First Health Commercial |
$1,382.25
|
| Rate for Payer: Humana Commercial |
$1,236.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,193.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,073.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$436.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,280.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,003.95
|
| Rate for Payer: PHCS Commercial |
$1,396.80
|
| Rate for Payer: United Healthcare All Payer |
$1,280.40
|
|
