|
REMOVAL OF BONE LESION
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.44 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,124.97
|
| Rate for Payer: Anthem Medicaid |
$502.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,139.58
|
| 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 |
$730.50
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,212.63
|
| Rate for Payer: First Health Commercial |
$1,387.95
|
| Rate for Payer: Humana Commercial |
$1,241.85
|
| Rate for Payer: Humana KY Medicaid |
$502.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$507.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,198.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,078.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,285.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.09
|
| Rate for Payer: PHCS Commercial |
$1,402.56
|
| Rate for Payer: United Healthcare All Payer |
$1,285.68
|
|
|
REMOVAL OF BONE LESION
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
76100448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.30 |
| Max. Negotiated Rate |
$1,402.56 |
| Rate for Payer: Aetna Commercial |
$1,124.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,139.58
|
| Rate for Payer: Cash Price |
$730.50
|
| Rate for Payer: Cigna Commercial |
$1,212.63
|
| Rate for Payer: First Health Commercial |
$1,387.95
|
| Rate for Payer: Humana Commercial |
$1,241.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,198.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,078.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,285.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,168.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.09
|
| Rate for Payer: PHCS Commercial |
$1,402.56
|
| Rate for Payer: United Healthcare All Payer |
$1,285.68
|
|
|
REMOVAL OF BONE LESION(P
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
HCPCS 23145
|
| Hospital Charge Code |
761P0448
|
|
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
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.34 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$515.96
|
| Rate for Payer: Ambetter Exchange |
$340.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$190.34
|
| Rate for Payer: Anthem Medicaid |
$219.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$340.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$409.10
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$572.15
|
| Rate for Payer: Healthspan PPO |
$666.12
|
| Rate for Payer: Humana Medicaid |
$219.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$447.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$340.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.60
|
| Rate for Payer: Molina Healthcare Passport |
$219.22
|
| Rate for Payer: Multiplan PHCS |
$795.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$443.20
|
| Rate for Payer: UHCCP Medicaid |
$199.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$340.92
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
OP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.67 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem Medicaid |
$455.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| 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 |
$662.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Humana KY Medicaid |
$455.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$460.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$464.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.25
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
REMOVAL OF CALCIUM DEPOSITS
|
Facility
|
IP
|
$1,325.00
|
|
|
Service Code
|
HCPCS 23000
|
| Hospital Charge Code |
76102916
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$397.50 |
| Max. Negotiated Rate |
$1,272.00 |
| Rate for Payer: Aetna Commercial |
$1,020.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,033.50
|
| Rate for Payer: Cash Price |
$662.50
|
| Rate for Payer: Cigna Commercial |
$1,099.75
|
| Rate for Payer: First Health Commercial |
$1,258.75
|
| Rate for Payer: Humana Commercial |
$1,126.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,086.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$977.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,166.00
|
| Rate for Payer: Ohio Health Group HMO |
$993.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.25
|
| Rate for Payer: PHCS Commercial |
$1,272.00
|
| Rate for Payer: United Healthcare All Payer |
$1,166.00
|
|
|
REMOVAL OF CERVIX
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
REMOVAL OF CERVIX
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$515.38
|
| Rate for Payer: Ambetter Exchange |
$352.47
|
| Rate for Payer: Anthem Medicaid |
$245.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$352.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$352.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$422.96
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$503.93
|
| Rate for Payer: Healthspan PPO |
$499.02
|
| Rate for Payer: Humana Medicaid |
$245.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$352.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.39
|
| Rate for Payer: Molina Healthcare Passport |
$245.48
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.21
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$247.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$352.47
|
|
|
REMOVAL OF CERVIX
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
76102205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
REMOVAL OF CERVIX(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 57530
|
| Hospital Charge Code |
761P2205
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.48 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$515.38
|
| Rate for Payer: Ambetter Exchange |
$352.47
|
| Rate for Payer: Anthem Medicaid |
$245.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$352.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$352.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$422.96
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$503.93
|
| Rate for Payer: Healthspan PPO |
$499.02
|
| Rate for Payer: Humana Medicaid |
$245.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$352.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$250.39
|
| Rate for Payer: Molina Healthcare Passport |
$245.48
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.21
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$247.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$352.47
|
|
|
REMOVAL OF CHEST TUBE
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,509.00 |
| Max. Negotiated Rate |
$4,828.80 |
| Rate for Payer: Aetna Commercial |
$3,873.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,923.40
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$4,174.90
|
| Rate for Payer: First Health Commercial |
$4,778.50
|
| Rate for Payer: Humana Commercial |
$4,275.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,712.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,509.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,426.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,376.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,470.70
|
| Rate for Payer: PHCS Commercial |
$4,828.80
|
| Rate for Payer: United Healthcare All Payer |
$4,426.40
|
|
|
REMOVAL OF CHEST TUBE
|
Professional
|
Both
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.17 |
| Max. Negotiated Rate |
$3,018.00 |
| Rate for Payer: Aetna Commercial |
$303.04
|
| Rate for Payer: Ambetter Exchange |
$168.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.17
|
| Rate for Payer: Anthem Medicaid |
$596.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.51
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$279.25
|
| Rate for Payer: Healthspan PPO |
$710.48
|
| Rate for Payer: Humana Medicaid |
$596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.89
|
| Rate for Payer: Molina Healthcare Passport |
$596.95
|
| Rate for Payer: Multiplan PHCS |
$3,018.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.39
|
| Rate for Payer: UHCCP Medicaid |
$142.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.76
|
|
|
REMOVAL OF CHEST TUBE
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
76101494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,729.82 |
| Max. Negotiated Rate |
$4,828.80 |
| Rate for Payer: Aetna Commercial |
$3,873.10
|
| Rate for Payer: Anthem Medicaid |
$1,729.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,923.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cash Price |
$2,515.00
|
| Rate for Payer: Cigna Commercial |
$4,174.90
|
| Rate for Payer: First Health Commercial |
$4,778.50
|
| Rate for Payer: Humana Commercial |
$4,275.50
|
| Rate for Payer: Humana KY Medicaid |
$1,729.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,747.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,712.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,764.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,426.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,376.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,470.70
|
| Rate for Payer: PHCS Commercial |
$4,828.80
|
| Rate for Payer: United Healthcare All Payer |
$4,426.40
|
|
|
REMOVAL OF CHEST TUBE(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761P1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.17 |
| Max. Negotiated Rate |
$710.48 |
| Rate for Payer: Aetna Commercial |
$303.04
|
| Rate for Payer: Ambetter Exchange |
$168.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.17
|
| Rate for Payer: Anthem Medicaid |
$596.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.51
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$279.25
|
| Rate for Payer: Healthspan PPO |
$710.48
|
| Rate for Payer: Humana Medicaid |
$596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$241.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.89
|
| Rate for Payer: Molina Healthcare Passport |
$596.95
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$219.39
|
| Rate for Payer: UHCCP Medicaid |
$142.98
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.76
|
|
|
REMOVAL OF CHEST TUBE(T
|
Facility
|
OP
|
$4,180.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761T1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,437.50 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$3,218.60
|
| Rate for Payer: Anthem Medicaid |
$1,437.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cigna Commercial |
$3,469.40
|
| Rate for Payer: First Health Commercial |
$3,971.00
|
| Rate for Payer: Humana Commercial |
$3,553.00
|
| Rate for Payer: Humana KY Medicaid |
$1,437.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,452.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,466.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,636.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,884.20
|
| Rate for Payer: PHCS Commercial |
$4,012.80
|
| Rate for Payer: United Healthcare All Payer |
$3,678.40
|
|
|
REMOVAL OF CHEST TUBE(T
|
Facility
|
IP
|
$4,180.00
|
|
|
Service Code
|
HCPCS 36595
|
| Hospital Charge Code |
761T1494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$4,012.80 |
| Rate for Payer: Aetna Commercial |
$3,218.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,260.40
|
| Rate for Payer: Cash Price |
$2,090.00
|
| Rate for Payer: Cigna Commercial |
$3,469.40
|
| Rate for Payer: First Health Commercial |
$3,971.00
|
| Rate for Payer: Humana Commercial |
$3,553.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,427.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,084.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,678.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,636.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,884.20
|
| Rate for Payer: PHCS Commercial |
$4,012.80
|
| Rate for Payer: United Healthcare All Payer |
$3,678.40
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.16 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.13 |
| Max. Negotiated Rate |
$1,671.63 |
| Rate for Payer: Aetna Commercial |
$1,671.63
|
| Rate for Payer: Ambetter Exchange |
$883.13
|
| Rate for Payer: Anthem Medicaid |
$639.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$883.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$883.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,059.76
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,601.22
|
| Rate for Payer: Healthspan PPO |
$1,643.54
|
| Rate for Payer: Humana Medicaid |
$639.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,297.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$883.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$651.91
|
| Rate for Payer: Molina Healthcare Passport |
$639.13
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.07
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$883.13
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$627.62 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem Medicaid |
$627.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Humana KY Medicaid |
$627.62
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$634.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
76101424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.45 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$1,038.92
|
| Rate for Payer: Ambetter Exchange |
$552.76
|
| Rate for Payer: Anthem Medicaid |
$526.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$663.31
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.49
|
| Rate for Payer: Healthspan PPO |
$1,021.46
|
| Rate for Payer: Humana Medicaid |
$526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.98
|
| Rate for Payer: Molina Healthcare Passport |
$526.45
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$718.59
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.76
|
|
|
REMOVAL OF CLOT IN GRAFT
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
76101423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.50 |
| Max. Negotiated Rate |
$1,752.00 |
| Rate for Payer: Aetna Commercial |
$1,405.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$1,514.75
|
| Rate for Payer: First Health Commercial |
$1,733.75
|
| Rate for Payer: Humana Commercial |
$1,551.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,606.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,259.25
|
| Rate for Payer: PHCS Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare All Payer |
$1,606.00
|
|
|
REMOVAL OF CLOT IN GRAFT(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 35876
|
| Hospital Charge Code |
761P1424
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$639.13 |
| Max. Negotiated Rate |
$1,671.63 |
| Rate for Payer: Aetna Commercial |
$1,671.63
|
| Rate for Payer: Ambetter Exchange |
$883.13
|
| Rate for Payer: Anthem Medicaid |
$639.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$883.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$883.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,059.76
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,601.22
|
| Rate for Payer: Healthspan PPO |
$1,643.54
|
| Rate for Payer: Humana Medicaid |
$639.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,297.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$883.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$651.91
|
| Rate for Payer: Molina Healthcare Passport |
$639.13
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.07
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$645.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$883.13
|
|
|
REMOVAL OF CLOT IN GRAFT(P
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35875
|
| Hospital Charge Code |
761P1423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.45 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$1,038.92
|
| Rate for Payer: Ambetter Exchange |
$552.76
|
| Rate for Payer: Anthem Medicaid |
$526.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$663.31
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cash Price |
$912.50
|
| Rate for Payer: Cigna Commercial |
$999.49
|
| Rate for Payer: Healthspan PPO |
$1,021.46
|
| Rate for Payer: Humana Medicaid |
$526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.98
|
| Rate for Payer: Molina Healthcare Passport |
$526.45
|
| Rate for Payer: Multiplan PHCS |
$1,095.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$718.59
|
| Rate for Payer: UHCCP Medicaid |
$638.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.76
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
76101823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
