|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$516.18
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REMOVAL OF ADENOIDS
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
REMOVAL OF ADENOIDS
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
76101712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$351.01
|
| Rate for Payer: Ambetter Exchange |
$233.21
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$233.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$233.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.85
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Healthspan PPO |
$296.01
|
| Rate for Payer: Humana Medicaid |
$173.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$311.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.80
|
| Rate for Payer: Molina Healthcare Passport |
$173.33
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$303.17
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.21
|
|
|
REMOVAL OF ADENOIDS(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 42836
|
| Hospital Charge Code |
761P1712
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.33 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$351.01
|
| Rate for Payer: Ambetter Exchange |
$233.21
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$233.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$233.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$279.85
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$350.32
|
| Rate for Payer: Healthspan PPO |
$296.01
|
| Rate for Payer: Humana Medicaid |
$173.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$311.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.80
|
| Rate for Payer: Molina Healthcare Passport |
$173.33
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$303.17
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$175.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$233.21
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.50 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$211.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$213.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$424.35
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
REMOVAL OF ANKLE/HEEL LESION
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
76100976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$741.25 |
| Rate for Payer: Aetna Commercial |
$614.44
|
| Rate for Payer: Ambetter Exchange |
$398.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.73
|
| Rate for Payer: Anthem Medicaid |
$294.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$477.71
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$679.21
|
| Rate for Payer: Healthspan PPO |
$741.25
|
| Rate for Payer: Humana Medicaid |
$294.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$502.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.91
|
| Rate for Payer: Molina Healthcare Passport |
$294.03
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.52
|
| Rate for Payer: UHCCP Medicaid |
$225.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.09
|
|
|
REMOVAL OF ANKLE/HEEL LESIO(P
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 28100
|
| Hospital Charge Code |
761P0976
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$741.25 |
| Rate for Payer: Aetna Commercial |
$614.44
|
| Rate for Payer: Ambetter Exchange |
$398.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.73
|
| Rate for Payer: Anthem Medicaid |
$294.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$477.71
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$679.21
|
| Rate for Payer: Healthspan PPO |
$741.25
|
| Rate for Payer: Humana Medicaid |
$294.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$502.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.91
|
| Rate for Payer: Molina Healthcare Passport |
$294.03
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.52
|
| Rate for Payer: UHCCP Medicaid |
$225.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.09
|
|
|
REMOVAL OF BLADDER STONE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.22 |
| Max. Negotiated Rate |
$761.65 |
| Rate for Payer: Aetna Commercial |
$761.65
|
| Rate for Payer: Ambetter Exchange |
$448.20
|
| Rate for Payer: Anthem Medicaid |
$385.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$537.84
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$671.31
|
| Rate for Payer: Healthspan PPO |
$609.01
|
| Rate for Payer: Humana Medicaid |
$385.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.92
|
| Rate for Payer: Molina Healthcare Passport |
$385.22
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$582.66
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.20
|
|
|
REMOVAL OF BLADDER STONE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.49 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF BLADDER STONE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 51050
|
| Hospital Charge Code |
76102883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Professional
|
Both
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$5,620.80 |
| Rate for Payer: Aetna Commercial |
$402.78
|
| Rate for Payer: Ambetter Exchange |
$170.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.04
|
| Rate for Payer: Anthem Medicaid |
$233.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.38
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$749.45
|
| Rate for Payer: Healthspan PPO |
$547.59
|
| Rate for Payer: Humana Medicaid |
$233.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.30
|
| Rate for Payer: Molina Healthcare Passport |
$233.63
|
| Rate for Payer: Multiplan PHCS |
$5,620.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.42
|
| Rate for Payer: UHCCP Medicaid |
$139.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.32
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,221.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$7,213.36
|
| Rate for Payer: Anthem Medicaid |
$3,221.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$7,775.44
|
| Rate for Payer: First Health Commercial |
$8,899.60
|
| Rate for Payer: Humana Commercial |
$7,962.80
|
| Rate for Payer: Humana KY Medicaid |
$3,221.66
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,254.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,286.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,463.92
|
| Rate for Payer: PHCS Commercial |
$8,993.28
|
| Rate for Payer: United Healthcare All Payer |
$8,243.84
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Professional
|
Both
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$5,431.80 |
| Rate for Payer: Aetna Commercial |
$557.61
|
| Rate for Payer: Ambetter Exchange |
$258.94
|
| Rate for Payer: Anthem Medicaid |
$349.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.73
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$975.78
|
| Rate for Payer: Healthspan PPO |
$505.08
|
| Rate for Payer: Humana Medicaid |
$349.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.98
|
| Rate for Payer: Molina Healthcare Passport |
$349.98
|
| Rate for Payer: Multiplan PHCS |
$5,431.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.62
|
| Rate for Payer: UHCCP Medicaid |
$3,168.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.94
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$9,368.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
76100355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,810.40 |
| Max. Negotiated Rate |
$8,993.28 |
| Rate for Payer: Aetna Commercial |
$7,213.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,307.04
|
| Rate for Payer: Cash Price |
$4,684.00
|
| Rate for Payer: Cigna Commercial |
$7,775.44
|
| Rate for Payer: First Health Commercial |
$8,899.60
|
| Rate for Payer: Humana Commercial |
$7,962.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,681.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,913.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,810.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,243.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,026.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,150.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,463.92
|
| Rate for Payer: PHCS Commercial |
$8,993.28
|
| Rate for Payer: United Healthcare All Payer |
$8,243.84
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
IP
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,715.90 |
| Max. Negotiated Rate |
$8,690.88 |
| Rate for Payer: Aetna Commercial |
$6,970.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,061.34
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$7,513.99
|
| Rate for Payer: First Health Commercial |
$8,600.35
|
| Rate for Payer: Humana Commercial |
$7,695.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,423.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,681.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,966.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,876.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,246.57
|
| Rate for Payer: PHCS Commercial |
$8,690.88
|
| Rate for Payer: United Healthcare All Payer |
$7,966.64
|
|
|
REMOVAL OF BONE FOR GRAFT
|
Facility
|
OP
|
$9,053.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,113.33 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,970.81
|
| Rate for Payer: Anthem Medicaid |
$3,113.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,061.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cash Price |
$4,526.50
|
| Rate for Payer: Cigna Commercial |
$7,513.99
|
| Rate for Payer: First Health Commercial |
$8,600.35
|
| Rate for Payer: Humana Commercial |
$7,695.05
|
| Rate for Payer: Humana KY Medicaid |
$3,113.33
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,145.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,423.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,681.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,175.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,966.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,789.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,242.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,876.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,246.57
|
| Rate for Payer: PHCS Commercial |
$8,690.88
|
| Rate for Payer: United Healthcare All Payer |
$7,966.64
|
|
|
REMOVAL OF BONE FOR GRAFT(P
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761P0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.75 |
| Max. Negotiated Rate |
$975.78 |
| Rate for Payer: Aetna Commercial |
$557.61
|
| Rate for Payer: Ambetter Exchange |
$258.94
|
| Rate for Payer: Anthem Medicaid |
$349.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.73
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cash Price |
$242.50
|
| Rate for Payer: Cigna Commercial |
$975.78
|
| Rate for Payer: Healthspan PPO |
$505.08
|
| Rate for Payer: Humana Medicaid |
$349.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.98
|
| Rate for Payer: Molina Healthcare Passport |
$349.98
|
| Rate for Payer: Multiplan PHCS |
$291.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.62
|
| Rate for Payer: UHCCP Medicaid |
$169.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.94
|
|
|
REMOVAL OF BONE FOR GRAFT(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761P0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.04 |
| Max. Negotiated Rate |
$749.45 |
| Rate for Payer: Aetna Commercial |
$402.78
|
| Rate for Payer: Ambetter Exchange |
$170.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$133.04
|
| Rate for Payer: Anthem Medicaid |
$233.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.38
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$749.45
|
| Rate for Payer: Healthspan PPO |
$547.59
|
| Rate for Payer: Humana Medicaid |
$233.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$238.30
|
| Rate for Payer: Molina Healthcare Passport |
$233.63
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.42
|
| Rate for Payer: UHCCP Medicaid |
$139.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.32
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761T0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761T0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
761T0356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE FOR GRAFT(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
761T0355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF BONE LESION
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.97 |
| Max. Negotiated Rate |
$1,091.60 |
| Rate for Payer: Aetna Commercial |
$1,010.00
|
| Rate for Payer: Ambetter Exchange |
$664.62
|
| Rate for Payer: Anthem Medicaid |
$500.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$664.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$664.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$797.54
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,091.60
|
| Rate for Payer: Healthspan PPO |
$914.85
|
| Rate for Payer: Humana Medicaid |
$500.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$858.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$664.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$510.99
|
| Rate for Payer: Molina Healthcare Passport |
$500.97
|
| Rate for Payer: Multiplan PHCS |
$876.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$864.01
|
| Rate for Payer: UHCCP Medicaid |
$511.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$505.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$664.62
|
|
