|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Aetna Commercial |
$1,120.35
|
| Rate for Payer: Anthem Medicaid |
$500.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,134.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$727.50
|
| 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: Humana KY Medicaid |
$500.37
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$505.47
|
| 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 |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$510.41
|
| 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
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
76101703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Aetna Commercial |
$188.22
|
| Rate for Payer: Ambetter Exchange |
$119.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.65
|
| Rate for Payer: Anthem Medicaid |
$75.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.88
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$238.27
|
| Rate for Payer: Healthspan PPO |
$200.70
|
| Rate for Payer: Humana Medicaid |
$75.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.09
|
| Rate for Payer: Molina Healthcare Passport |
$75.58
|
| Rate for Payer: Multiplan PHCS |
$873.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.79
|
| Rate for Payer: UHCCP Medicaid |
$86.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.07
|
|
|
REMOVAL FOREIGN BODY PHARYNX
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
45000263
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$490.00
|
| 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: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| 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 |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| 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(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761P1703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$188.22
|
| Rate for Payer: Ambetter Exchange |
$119.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.65
|
| Rate for Payer: Anthem Medicaid |
$75.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$142.88
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$238.27
|
| Rate for Payer: Healthspan PPO |
$200.70
|
| Rate for Payer: Humana Medicaid |
$75.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.09
|
| Rate for Payer: Molina Healthcare Passport |
$75.58
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.79
|
| Rate for Payer: UHCCP Medicaid |
$86.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.07
|
|
|
REMOVAL FOREIGN BODY PHARYNX(T
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761T1703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.02 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$490.00
|
| 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: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| 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 |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| 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(T
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 42809
|
| Hospital Charge Code |
761T1703
|
|
Hospital Revenue Code
|
761
|
| 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 THIGH/KNE
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$747.04 |
| Rate for Payer: Aetna Commercial |
$584.43
|
| Rate for Payer: Ambetter Exchange |
$382.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$245.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.42
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$643.19
|
| Rate for Payer: Healthspan PPO |
$747.04
|
| Rate for Payer: Humana Medicaid |
$245.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.91
|
| Rate for Payer: Molina Healthcare Passport |
$245.99
|
| Rate for Payer: Multiplan PHCS |
$497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.70
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.85
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Facility
|
OP
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.09 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$638.33
|
| Rate for Payer: Anthem Medicaid |
$285.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$646.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$688.07
|
| Rate for Payer: First Health Commercial |
$787.55
|
| Rate for Payer: Humana Commercial |
$704.65
|
| Rate for Payer: Humana KY Medicaid |
$285.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$287.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$729.52
|
| Rate for Payer: Ohio Health Group HMO |
$621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.01
|
| Rate for Payer: PHCS Commercial |
$795.84
|
| Rate for Payer: United Healthcare All Payer |
$729.52
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
761P0828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.29 |
| Max. Negotiated Rate |
$747.04 |
| Rate for Payer: Aetna Commercial |
$584.43
|
| Rate for Payer: Ambetter Exchange |
$382.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.29
|
| Rate for Payer: Anthem Medicaid |
$245.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.42
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$643.19
|
| Rate for Payer: Healthspan PPO |
$747.04
|
| Rate for Payer: Humana Medicaid |
$245.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$499.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.91
|
| Rate for Payer: Molina Healthcare Passport |
$245.99
|
| Rate for Payer: Multiplan PHCS |
$497.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.70
|
| Rate for Payer: UHCCP Medicaid |
$217.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.85
|
|
|
REMOVAL FOREIGN BODY THIGH/KNE
|
Facility
|
IP
|
$829.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
76100828
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$795.84 |
| Rate for Payer: Aetna Commercial |
$638.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$646.62
|
| Rate for Payer: Cash Price |
$414.50
|
| Rate for Payer: Cigna Commercial |
$688.07
|
| Rate for Payer: First Health Commercial |
$787.55
|
| Rate for Payer: Humana Commercial |
$704.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$729.52
|
| Rate for Payer: Ohio Health Group HMO |
$621.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.01
|
| Rate for Payer: PHCS Commercial |
$795.84
|
| Rate for Payer: United Healthcare All Payer |
$729.52
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
|
|
REMOVAL IMP W/O CAPSULECTOMY
|
Professional
|
Both
|
$750.00
|
|
| Hospital Charge Code |
22200046
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
|
|
REMOVAL IMP W/O CAPSULECTOMY
|
Facility
|
OP
|
$750.00
|
|
| Hospital Charge Code |
22200046
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| 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: Humana KY Medicaid |
$257.93
|
| 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 |
$225.00
|
| 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 IMP W/O CAPSULECTOMY
|
Facility
|
IP
|
$750.00
|
|
| Hospital Charge Code |
22200046
|
|
Hospital Revenue Code
|
222
|
| 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 INTRANASAL LESION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.50 |
| Max. Negotiated Rate |
$923.36 |
| Rate for Payer: Aetna Commercial |
$461.76
|
| Rate for Payer: Ambetter Exchange |
$377.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.52
|
| Rate for Payer: Anthem Medicaid |
$173.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$377.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$453.23
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$450.44
|
| Rate for Payer: Healthspan PPO |
$923.36
|
| Rate for Payer: Humana Medicaid |
$173.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$377.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.97
|
| Rate for Payer: Molina Healthcare Passport |
$173.50
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$491.00
|
| Rate for Payer: UHCCP Medicaid |
$186.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.69
|
|
|
REMOVAL INTRANASAL LESION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL INTRANASAL LESION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
76101122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL INTRANASAL LESION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 30117
|
| Hospital Charge Code |
761P1122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.50 |
| Max. Negotiated Rate |
$923.36 |
| Rate for Payer: Aetna Commercial |
$461.76
|
| Rate for Payer: Ambetter Exchange |
$377.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.52
|
| Rate for Payer: Anthem Medicaid |
$173.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$377.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$453.23
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$450.44
|
| Rate for Payer: Healthspan PPO |
$923.36
|
| Rate for Payer: Humana Medicaid |
$173.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$377.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.97
|
| Rate for Payer: Molina Healthcare Passport |
$173.50
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$491.00
|
| Rate for Payer: UHCCP Medicaid |
$186.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.69
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,141.54 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$2,091.87
|
| Rate for Payer: Ambetter Exchange |
$1,207.86
|
| Rate for Payer: Anthem Medicaid |
$1,141.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,207.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,207.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,449.43
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$1,864.86
|
| Rate for Payer: Healthspan PPO |
$1,672.64
|
| Rate for Payer: Humana Medicaid |
$1,141.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,750.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,207.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,164.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,141.54
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,570.22
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,152.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,207.86
|
|
|
REMOVAL KIDNEY OPEN RADICAL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
76102046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,290.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,741.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,967.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
REMOVAL KIDNEY OPEN RADICAL(P
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
HCPCS 50230
|
| Hospital Charge Code |
761P2046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,141.54 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$2,091.87
|
| Rate for Payer: Ambetter Exchange |
$1,207.86
|
| Rate for Payer: Anthem Medicaid |
$1,141.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,207.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,207.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,449.43
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$1,864.86
|
| Rate for Payer: Healthspan PPO |
$1,672.64
|
| Rate for Payer: Humana Medicaid |
$1,141.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,750.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,207.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,164.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,141.54
|
| Rate for Payer: Multiplan PHCS |
$2,580.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,570.22
|
| Rate for Payer: UHCCP Medicaid |
$1,505.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,152.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,207.86
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,060.80 |
| Rate for Payer: Anthem Medicaid |
$1,040.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$1,040.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,060.80
|
| Rate for Payer: Molina Healthcare Passport |
$1,040.00
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,050.40
|
|
|
REMOVAL MESH,ABDOM WALL CLOSUR
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 22999
|
| Hospital Charge Code |
76102797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
