|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
IP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
45000248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.20 |
| Max. Negotiated Rate |
$1,127.04 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.06
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
OP
|
$1,174.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
45000248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$403.74 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$903.98
|
| Rate for Payer: Anthem Medicaid |
$403.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cash Price |
$587.00
|
| Rate for Payer: Cigna Commercial |
$974.42
|
| Rate for Payer: First Health Commercial |
$1,115.30
|
| Rate for Payer: Humana Commercial |
$997.90
|
| Rate for Payer: Humana KY Medicaid |
$403.74
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$407.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,033.12
|
| Rate for Payer: Ohio Health Group HMO |
$880.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.06
|
| Rate for Payer: PHCS Commercial |
$1,127.04
|
| Rate for Payer: United Healthcare All Payer |
$1,033.12
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
76101631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.80 |
| Max. Negotiated Rate |
$1,080.96 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
|
REMOVAL OF FOREIGN BODY(P
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761P0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.32 |
| Max. Negotiated Rate |
$583.41 |
| Rate for Payer: Aetna Commercial |
$364.70
|
| Rate for Payer: Ambetter Exchange |
$235.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.32
|
| Rate for Payer: Anthem Medicaid |
$162.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$235.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$282.64
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$400.67
|
| Rate for Payer: Healthspan PPO |
$583.41
|
| Rate for Payer: Humana Medicaid |
$162.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$235.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.86
|
| Rate for Payer: Molina Healthcare Passport |
$162.61
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$306.19
|
| Rate for Payer: UHCCP Medicaid |
$132.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$235.53
|
|
|
REMOVAL OF FOREIGN BODY(T
|
Facility
|
IP
|
$5,577.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761T0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,673.10 |
| Max. Negotiated Rate |
$5,353.92 |
| Rate for Payer: Aetna Commercial |
$4,294.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,350.06
|
| Rate for Payer: Cash Price |
$2,788.50
|
| Rate for Payer: Cigna Commercial |
$4,628.91
|
| Rate for Payer: First Health Commercial |
$5,298.15
|
| Rate for Payer: Humana Commercial |
$4,740.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,573.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,851.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,848.13
|
| Rate for Payer: PHCS Commercial |
$5,353.92
|
| Rate for Payer: United Healthcare All Payer |
$4,907.76
|
|
|
REMOVAL OF FOREIGN BODY(T
|
Facility
|
OP
|
$5,577.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
761T0335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,917.93 |
| Max. Negotiated Rate |
$5,353.92 |
| Rate for Payer: Aetna Commercial |
$4,294.29
|
| Rate for Payer: Anthem Medicaid |
$1,917.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,350.06
|
| 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 |
$2,788.50
|
| Rate for Payer: Cash Price |
$2,788.50
|
| Rate for Payer: Cigna Commercial |
$4,628.91
|
| Rate for Payer: First Health Commercial |
$5,298.15
|
| Rate for Payer: Humana Commercial |
$4,740.45
|
| Rate for Payer: Humana KY Medicaid |
$1,917.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,573.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,461.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,851.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,848.13
|
| Rate for Payer: PHCS Commercial |
$5,353.92
|
| Rate for Payer: United Healthcare All Payer |
$4,907.76
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
IP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,200.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.20
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
REMOVAL OF HEEL SPUR
|
Facility
|
OP
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.58 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,062.60
|
| Rate for Payer: Anthem Medicaid |
$474.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,076.40
|
| 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 |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$1,145.40
|
| Rate for Payer: First Health Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial |
$1,173.00
|
| Rate for Payer: Humana KY Medicaid |
$474.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$479.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,131.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,018.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,214.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,200.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$952.20
|
| Rate for Payer: PHCS Commercial |
$1,324.80
|
| Rate for Payer: United Healthcare All Payer |
$1,214.40
|
|
|
REMOVAL OF HEEL SPUR
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
76100985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.15 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$555.53
|
| Rate for Payer: Ambetter Exchange |
$346.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.15
|
| Rate for Payer: Anthem Medicaid |
$309.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.52
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$602.53
|
| Rate for Payer: Healthspan PPO |
$650.56
|
| Rate for Payer: Humana Medicaid |
$309.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$445.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$346.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.60
|
| Rate for Payer: Molina Healthcare Passport |
$309.41
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.15
|
| Rate for Payer: UHCCP Medicaid |
$194.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.27
|
|
|
REMOVAL OF HEEL SPUR(P
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 28119
|
| Hospital Charge Code |
761P0985
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.15 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$555.53
|
| Rate for Payer: Ambetter Exchange |
$346.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.15
|
| Rate for Payer: Anthem Medicaid |
$309.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$346.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.52
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$602.53
|
| Rate for Payer: Healthspan PPO |
$650.56
|
| Rate for Payer: Humana Medicaid |
$309.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$445.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$346.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.60
|
| Rate for Payer: Molina Healthcare Passport |
$309.41
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.15
|
| Rate for Payer: UHCCP Medicaid |
$194.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.27
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.41 |
| Max. Negotiated Rate |
$1,346.45 |
| Rate for Payer: Aetna Commercial |
$1,232.74
|
| Rate for Payer: Ambetter Exchange |
$788.54
|
| Rate for Payer: Anthem Medicaid |
$631.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$788.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$788.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$946.25
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,346.45
|
| Rate for Payer: Healthspan PPO |
$1,116.60
|
| Rate for Payer: Humana Medicaid |
$631.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$788.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$788.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.04
|
| Rate for Payer: Molina Healthcare Passport |
$631.41
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,025.10
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$788.54
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
76100774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,209.08 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,398.22
|
| Rate for Payer: Ambetter Exchange |
$1,510.94
|
| Rate for Payer: Anthem Medicaid |
$1,209.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,510.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,510.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,813.13
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$2,554.62
|
| Rate for Payer: Healthspan PPO |
$2,172.27
|
| Rate for Payer: Humana Medicaid |
$1,209.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,008.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,510.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,233.26
|
| Rate for Payer: Molina Healthcare Passport |
$1,209.08
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,964.22
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,221.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,510.94
|
|
|
REMOVAL OF HIP PROSTHESIS
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
76100775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL OF HIP PROSTHESIS(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 27091
|
| Hospital Charge Code |
761P0775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,209.08 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,398.22
|
| Rate for Payer: Ambetter Exchange |
$1,510.94
|
| Rate for Payer: Anthem Medicaid |
$1,209.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,510.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,510.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,813.13
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$2,554.62
|
| Rate for Payer: Healthspan PPO |
$2,172.27
|
| Rate for Payer: Humana Medicaid |
$1,209.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,008.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,510.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,510.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,233.26
|
| Rate for Payer: Molina Healthcare Passport |
$1,209.08
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,964.22
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,221.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,510.94
|
|
|
REMOVAL OF HIP PROSTHESIS(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 27090
|
| Hospital Charge Code |
761P0774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.41 |
| Max. Negotiated Rate |
$1,346.45 |
| Rate for Payer: Aetna Commercial |
$1,232.74
|
| Rate for Payer: Ambetter Exchange |
$788.54
|
| Rate for Payer: Anthem Medicaid |
$631.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$788.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$788.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$946.25
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,346.45
|
| Rate for Payer: Healthspan PPO |
$1,116.60
|
| Rate for Payer: Humana Medicaid |
$631.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,032.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$788.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$788.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.04
|
| Rate for Payer: Molina Healthcare Passport |
$631.41
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,025.10
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$788.54
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.91 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem Medicaid |
$300.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| 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 |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Humana KY Medicaid |
$300.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$303.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$306.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REMOVAL OF HUMERUS LESION
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$673.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$682.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$726.25
|
| Rate for Payer: First Health Commercial |
$831.25
|
| Rate for Payer: Humana Commercial |
$743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$717.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$645.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$770.00
|
| Rate for Payer: Ohio Health Group HMO |
$656.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$761.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.75
|
| Rate for Payer: PHCS Commercial |
$840.00
|
| Rate for Payer: United Healthcare All Payer |
$770.00
|
|
|
REMOVAL OF HUMERUS LESION
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
76100449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,081.72 |
| Rate for Payer: Aetna Commercial |
$985.40
|
| Rate for Payer: Ambetter Exchange |
$650.11
|
| Rate for Payer: Anthem Medicaid |
$470.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$650.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$780.13
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$1,081.72
|
| Rate for Payer: Healthspan PPO |
$892.56
|
| Rate for Payer: Humana Medicaid |
$470.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$650.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.44
|
| Rate for Payer: Molina Healthcare Passport |
$470.04
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$845.14
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$650.11
|
|
|
REMOVAL OF HUMERUS LESION(P
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 23156
|
| Hospital Charge Code |
761P0449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,081.72 |
| Rate for Payer: Aetna Commercial |
$985.40
|
| Rate for Payer: Ambetter Exchange |
$650.11
|
| Rate for Payer: Anthem Medicaid |
$470.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$650.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$780.13
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$1,081.72
|
| Rate for Payer: Healthspan PPO |
$892.56
|
| Rate for Payer: Humana Medicaid |
$470.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$650.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.44
|
| Rate for Payer: Molina Healthcare Passport |
$470.04
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$845.14
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$650.11
|
|
|
REMOVAL OF HYDROCELES
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 55041
|
| Hospital Charge Code |
76103040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Aetna Commercial |
$819.40
|
| Rate for Payer: Ambetter Exchange |
$484.26
|
| Rate for Payer: Anthem Medicaid |
$436.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$484.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$581.11
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$724.06
|
| Rate for Payer: Healthspan PPO |
$793.38
|
| Rate for Payer: Humana Medicaid |
$436.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$484.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$445.33
|
| Rate for Payer: Molina Healthcare Passport |
$436.60
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$629.54
|
| Rate for Payer: UHCCP Medicaid |
$425.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$440.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$484.26
|
|
|
REMOVAL OF IMPACTED CERUMEN
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
76102535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
REMOVAL OF IMPACTED CERUMEN
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
76102535
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
