|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
761P1823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,787.41 |
| Rate for Payer: Aetna Commercial |
$1,787.41
|
| Rate for Payer: Ambetter Exchange |
$1,180.25
|
| Rate for Payer: Anthem Medicaid |
$812.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,180.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,180.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,662.37
|
| Rate for Payer: Healthspan PPO |
$1,507.36
|
| Rate for Payer: Humana Medicaid |
$812.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,583.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,180.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$828.48
|
| Rate for Payer: Molina Healthcare Passport |
$812.24
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,534.33
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$820.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,180.25
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Facility
|
OP
|
$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 Medicaid |
$722.19
|
| 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: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| 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: Molina Healthcare Medicaid |
$736.68
|
| 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
|
|
|
REMOVAL OF COLON/ILEOCOLOSTOMY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44160
|
| Hospital Charge Code |
76101823
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,787.41 |
| Rate for Payer: Aetna Commercial |
$1,787.41
|
| Rate for Payer: Ambetter Exchange |
$1,180.25
|
| Rate for Payer: Anthem Medicaid |
$812.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,180.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,180.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,662.37
|
| Rate for Payer: Healthspan PPO |
$1,507.36
|
| Rate for Payer: Humana Medicaid |
$812.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,583.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,180.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$828.48
|
| Rate for Payer: Molina Healthcare Passport |
$812.24
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,534.33
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$820.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,180.25
|
|
|
REMOVAL OF EPIDIDYMIS
|
Professional
|
Both
|
$990.00
|
|
|
Service Code
|
HCPCS 54860
|
| Hospital Charge Code |
76103020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.17 |
| Max. Negotiated Rate |
$674.78 |
| Rate for Payer: Aetna Commercial |
$674.78
|
| Rate for Payer: Ambetter Exchange |
$397.23
|
| Rate for Payer: Anthem Medicaid |
$327.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$397.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$397.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$476.68
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Healthspan PPO |
$653.36
|
| Rate for Payer: Humana Medicaid |
$327.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$568.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$397.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$333.71
|
| Rate for Payer: Molina Healthcare Passport |
$327.17
|
| Rate for Payer: Multiplan PHCS |
$594.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$516.40
|
| Rate for Payer: UHCCP Medicaid |
$346.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$330.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$397.23
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,349.00 |
| Max. Negotiated Rate |
$7,516.80 |
| Rate for Payer: Aetna Commercial |
$6,029.10
|
| Rate for Payer: Anthem Medicaid |
$2,692.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,107.40
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$6,498.90
|
| Rate for Payer: First Health Commercial |
$7,438.50
|
| Rate for Payer: Humana Commercial |
$6,655.50
|
| Rate for Payer: Humana KY Medicaid |
$2,692.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,720.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,420.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,778.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,746.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,890.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,872.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,812.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,402.70
|
| Rate for Payer: PHCS Commercial |
$7,516.80
|
| Rate for Payer: United Healthcare All Payer |
$6,890.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Professional
|
Both
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,780.52 |
| Max. Negotiated Rate |
$6,343.12 |
| Rate for Payer: Aetna Commercial |
$6,343.12
|
| Rate for Payer: Ambetter Exchange |
$4,086.94
|
| Rate for Payer: Anthem Medicaid |
$1,780.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4,086.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,086.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,904.33
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$5,499.85
|
| Rate for Payer: Healthspan PPO |
$5,349.27
|
| Rate for Payer: Humana Medicaid |
$1,780.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,901.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4,086.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,816.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,780.52
|
| Rate for Payer: Multiplan PHCS |
$4,698.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,313.02
|
| Rate for Payer: UHCCP Medicaid |
$2,740.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,798.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,086.94
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,349.00 |
| Max. Negotiated Rate |
$7,516.80 |
| Rate for Payer: Aetna Commercial |
$6,029.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,107.40
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$6,498.90
|
| Rate for Payer: First Health Commercial |
$7,438.50
|
| Rate for Payer: Humana Commercial |
$6,655.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,420.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,778.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,890.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,872.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,812.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,402.70
|
| Rate for Payer: PHCS Commercial |
$7,516.80
|
| Rate for Payer: United Healthcare All Payer |
$6,890.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.90
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,664.75
|
| Rate for Payer: Humana Commercial |
$2,384.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,440.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,935.45
|
| Rate for Payer: PHCS Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Payer |
$2,468.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$841.50 |
| Max. Negotiated Rate |
$2,692.80 |
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Anthem Medicaid |
$964.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,187.90
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$2,328.15
|
| Rate for Payer: First Health Commercial |
$2,664.75
|
| Rate for Payer: Humana Commercial |
$2,384.25
|
| Rate for Payer: Humana KY Medicaid |
$964.64
|
| Rate for Payer: Kentucky WC Medicaid |
$974.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,300.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,070.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$983.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,468.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,103.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,440.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,935.45
|
| Rate for Payer: PHCS Commercial |
$2,692.80
|
| Rate for Payer: United Healthcare All Payer |
$2,468.40
|
|
|
REMOVAL OF ESOPHAGUS
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
76101718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$981.75 |
| Max. Negotiated Rate |
$3,850.15 |
| Rate for Payer: Aetna Commercial |
$3,850.15
|
| Rate for Payer: Ambetter Exchange |
$2,802.31
|
| Rate for Payer: Anthem Medicaid |
$1,509.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,802.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,802.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,362.77
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$3,615.74
|
| Rate for Payer: Healthspan PPO |
$3,246.90
|
| Rate for Payer: Humana Medicaid |
$1,509.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,362.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,802.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,539.22
|
| Rate for Payer: Molina Healthcare Passport |
$1,509.04
|
| Rate for Payer: Multiplan PHCS |
$1,683.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,643.00
|
| Rate for Payer: UHCCP Medicaid |
$981.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,802.31
|
|
|
REMOVAL OF ESOPHAGUS(P
|
Professional
|
Both
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
761P1720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,780.52 |
| Max. Negotiated Rate |
$6,343.12 |
| Rate for Payer: Aetna Commercial |
$6,343.12
|
| Rate for Payer: Ambetter Exchange |
$4,086.94
|
| Rate for Payer: Anthem Medicaid |
$1,780.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4,086.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,086.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,904.33
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$5,499.85
|
| Rate for Payer: Healthspan PPO |
$5,349.27
|
| Rate for Payer: Humana Medicaid |
$1,780.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,901.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4,086.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,086.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,816.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,780.52
|
| Rate for Payer: Multiplan PHCS |
$4,698.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,313.02
|
| Rate for Payer: UHCCP Medicaid |
$2,740.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,798.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$4,086.94
|
|
|
REMOVAL OF ESOPHAGUS(P
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
761P1718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$981.75 |
| Max. Negotiated Rate |
$3,850.15 |
| Rate for Payer: Aetna Commercial |
$3,850.15
|
| Rate for Payer: Ambetter Exchange |
$2,802.31
|
| Rate for Payer: Anthem Medicaid |
$1,509.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,802.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,802.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,362.77
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$3,615.74
|
| Rate for Payer: Healthspan PPO |
$3,246.90
|
| Rate for Payer: Humana Medicaid |
$1,509.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,362.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,802.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,802.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,539.22
|
| Rate for Payer: Molina Healthcare Passport |
$1,509.04
|
| Rate for Payer: Multiplan PHCS |
$1,683.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,643.00
|
| Rate for Payer: UHCCP Medicaid |
$981.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,524.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,802.31
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.75 |
| Max. Negotiated Rate |
$1,168.85 |
| Rate for Payer: Aetna Commercial |
$1,168.85
|
| Rate for Payer: Ambetter Exchange |
$750.70
|
| Rate for Payer: Anthem Medicaid |
$634.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$750.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$900.84
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$1,120.01
|
| Rate for Payer: Healthspan PPO |
$985.72
|
| Rate for Payer: Humana Medicaid |
$634.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$750.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.85
|
| Rate for Payer: Molina Healthcare Passport |
$634.17
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$975.91
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$750.70
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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 ESOPHAGUS POUCH
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
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 ESOPHAGUS POUCH(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
761P1722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.75 |
| Max. Negotiated Rate |
$1,168.85 |
| Rate for Payer: Aetna Commercial |
$1,168.85
|
| Rate for Payer: Ambetter Exchange |
$750.70
|
| Rate for Payer: Anthem Medicaid |
$634.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$750.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$900.84
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$1,120.01
|
| Rate for Payer: Healthspan PPO |
$985.72
|
| Rate for Payer: Humana Medicaid |
$634.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$750.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.85
|
| Rate for Payer: Molina Healthcare Passport |
$634.17
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$975.91
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$750.70
|
|
|
REMOVAL OF EXTERNAL EAR
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 69120
|
| Hospital Charge Code |
76102749
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.53 |
| Max. Negotiated Rate |
$578.82 |
| Rate for Payer: Aetna Commercial |
$561.78
|
| Rate for Payer: Ambetter Exchange |
$357.88
|
| Rate for Payer: Anthem Medicaid |
$138.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$357.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$357.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$429.46
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$578.82
|
| Rate for Payer: Healthspan PPO |
$498.32
|
| Rate for Payer: Humana Medicaid |
$138.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$357.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.30
|
| Rate for Payer: Molina Healthcare Passport |
$138.53
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$465.24
|
| Rate for Payer: UHCCP Medicaid |
$143.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$357.88
|
|
|
REMOVAL OF FB FROM CERVIX
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$112.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REMOVAL OF FB FROM CERVIX
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REMOVAL OF FB FROM CERVIX
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$755.82 |
| Rate for Payer: Anthem Medicaid |
$741.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$741.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$755.82
|
| Rate for Payer: Molina Healthcare Passport |
$741.00
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$748.41
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$1,525.23
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.45 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.00 |
| Max. Negotiated Rate |
$1,180.80 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.70
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
REMOVAL OF FINGER LESION
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.99 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$623.01
|
| Rate for Payer: Ambetter Exchange |
$429.41
|
| Rate for Payer: Anthem Medicaid |
$265.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$429.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$429.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$515.29
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$691.50
|
| Rate for Payer: Healthspan PPO |
$564.31
|
| Rate for Payer: Humana Medicaid |
$265.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$429.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.31
|
| Rate for Payer: Molina Healthcare Passport |
$265.99
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$558.23
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$429.41
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem Medicaid |
$423.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Humana KY Medicaid |
$423.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$427.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$431.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$848.70
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
REMOVAL OF FINGER LESION(P
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
761P0682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.99 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$623.01
|
| Rate for Payer: Ambetter Exchange |
$429.41
|
| Rate for Payer: Anthem Medicaid |
$265.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$429.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$429.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$515.29
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$691.50
|
| Rate for Payer: Healthspan PPO |
$564.31
|
| Rate for Payer: Humana Medicaid |
$265.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$429.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.31
|
| Rate for Payer: Molina Healthcare Passport |
$265.99
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$558.23
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$429.41
|
|
