|
REMOVAL OF LUNG(P
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 32484
|
| Hospital Charge Code |
761P1191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,111.27 |
| Max. Negotiated Rate |
$2,417.70 |
| Rate for Payer: Aetna Commercial |
$2,417.70
|
| Rate for Payer: Ambetter Exchange |
$1,351.10
|
| Rate for Payer: Anthem Medicaid |
$1,111.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,351.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,351.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,621.32
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,303.54
|
| Rate for Payer: Healthspan PPO |
$1,887.68
|
| Rate for Payer: Humana Medicaid |
$1,111.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,005.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,351.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,351.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,133.50
|
| Rate for Payer: Molina Healthcare Passport |
$1,111.27
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,756.43
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,122.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,351.10
|
|
|
REMOVAL OF LUNG(P
|
Professional
|
Both
|
$3,400.00
|
|
|
Service Code
|
HCPCS 32440
|
| Hospital Charge Code |
761P1188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,146.00 |
| Max. Negotiated Rate |
$2,666.93 |
| Rate for Payer: Aetna Commercial |
$2,666.93
|
| Rate for Payer: Ambetter Exchange |
$1,477.69
|
| Rate for Payer: Anthem Medicaid |
$1,146.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,477.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,477.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,773.23
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,541.35
|
| Rate for Payer: Healthspan PPO |
$2,082.27
|
| Rate for Payer: Humana Medicaid |
$1,146.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,184.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,477.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,168.92
|
| Rate for Payer: Molina Healthcare Passport |
$1,146.00
|
| Rate for Payer: Multiplan PHCS |
$2,040.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,921.00
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,157.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,477.69
|
|
|
REMOVAL OF NAIL PLATE
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
76100096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$256.80 |
| Rate for Payer: Aetna Commercial |
$90.59
|
| Rate for Payer: Ambetter Exchange |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.17
|
| Rate for Payer: Anthem Medicaid |
$46.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.94
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$127.59
|
| Rate for Payer: Healthspan PPO |
$111.39
|
| Rate for Payer: Humana Medicaid |
$46.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.12
|
| Rate for Payer: Molina Healthcare Passport |
$46.20
|
| Rate for Payer: Multiplan PHCS |
$256.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.01
|
| Rate for Payer: UHCCP Medicaid |
$28.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.78
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
45000035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
76100096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
45000035
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
76100096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.19 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
REMOVAL OF NAIL PLATE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
761P0096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$127.59 |
| Rate for Payer: Aetna Commercial |
$90.59
|
| Rate for Payer: Ambetter Exchange |
$50.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.17
|
| Rate for Payer: Anthem Medicaid |
$46.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$127.59
|
| Rate for Payer: Healthspan PPO |
$111.39
|
| Rate for Payer: Humana Medicaid |
$46.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.12
|
| Rate for Payer: Molina Healthcare Passport |
$46.20
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.01
|
| Rate for Payer: UHCCP Medicaid |
$28.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.78
|
|
|
REMOVAL OF NAIL PLATE(T
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
761T0096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
REMOVAL OF NAIL PLATE(T
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
HCPCS 11730
|
| Hospital Charge Code |
761T0096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
REMOVAL OF NECK WRINKLES
|
Professional
|
Both
|
$11,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$7,842.34 |
| Rate for Payer: Aetna Commercial |
$1,766.84
|
| Rate for Payer: Anthem Medicaid |
$735.05
|
| Rate for Payer: Cash Price |
$5,601.67
|
| Rate for Payer: Cash Price |
$5,601.67
|
| Rate for Payer: Cigna Commercial |
$1,663.58
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$735.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,131.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.75
|
| Rate for Payer: Molina Healthcare Passport |
$735.05
|
| Rate for Payer: Multiplan PHCS |
$6,722.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,842.34
|
| Rate for Payer: UHCCP Medicaid |
$3,921.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.40
|
|
|
REMOVAL OF NECK WRINKLES
|
Facility
|
OP
|
$11,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,382.66 |
| Max. Negotiated Rate |
$10,755.21 |
| Rate for Payer: Aetna Commercial |
$8,626.57
|
| Rate for Payer: Anthem Medicaid |
$3,852.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,738.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$5,601.67
|
| Rate for Payer: Cash Price |
$5,601.67
|
| Rate for Payer: Cigna Commercial |
$9,298.77
|
| Rate for Payer: First Health Commercial |
$10,643.17
|
| Rate for Payer: Humana Commercial |
$9,522.84
|
| Rate for Payer: Humana KY Medicaid |
$3,852.83
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,892.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,186.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,268.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,930.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,858.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,746.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,730.30
|
| Rate for Payer: PHCS Commercial |
$10,755.21
|
| Rate for Payer: United Healthcare All Payer |
$9,858.94
|
|
|
REMOVAL OF NECK WRINKLES
|
Facility
|
IP
|
$11,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,361.00 |
| Max. Negotiated Rate |
$10,755.21 |
| Rate for Payer: Aetna Commercial |
$8,626.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,738.61
|
| Rate for Payer: Cash Price |
$5,601.67
|
| Rate for Payer: Cigna Commercial |
$9,298.77
|
| Rate for Payer: First Health Commercial |
$10,643.17
|
| Rate for Payer: Humana Commercial |
$9,522.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,186.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,268.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,361.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,858.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,746.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,730.30
|
| Rate for Payer: PHCS Commercial |
$10,755.21
|
| Rate for Payer: United Healthcare All Payer |
$9,858.94
|
|
|
REMOVAL OF NECK WRINKLES(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
761P0218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$1,766.84
|
| Rate for Payer: Anthem Medicaid |
$735.05
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$1,663.58
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$735.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,131.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.75
|
| Rate for Payer: Molina Healthcare Passport |
$735.05
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,500.00
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$742.40
|
|
|
REMOVAL OF NECK WRINKLES(T
|
Facility
|
OP
|
$6,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
761T0218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,133.33 |
| Max. Negotiated Rate |
$5,955.21 |
| Rate for Payer: Aetna Commercial |
$4,776.57
|
| Rate for Payer: Anthem Medicaid |
$2,133.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,838.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cigna Commercial |
$5,148.77
|
| Rate for Payer: First Health Commercial |
$5,893.17
|
| Rate for Payer: Humana Commercial |
$5,272.84
|
| Rate for Payer: Humana KY Medicaid |
$2,133.33
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,155.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,086.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,578.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,176.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,458.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,652.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,396.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,280.30
|
| Rate for Payer: PHCS Commercial |
$5,955.21
|
| Rate for Payer: United Healthcare All Payer |
$5,458.94
|
|
|
REMOVAL OF NECK WRINKLES(T
|
Facility
|
IP
|
$6,203.34
|
|
|
Service Code
|
HCPCS 15825
|
| Hospital Charge Code |
761T0218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,861.00 |
| Max. Negotiated Rate |
$5,955.21 |
| Rate for Payer: Aetna Commercial |
$4,776.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,838.61
|
| Rate for Payer: Cash Price |
$3,101.67
|
| Rate for Payer: Cigna Commercial |
$5,148.77
|
| Rate for Payer: First Health Commercial |
$5,893.17
|
| Rate for Payer: Humana Commercial |
$5,272.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,086.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,578.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,861.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,458.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,652.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,396.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,280.30
|
| Rate for Payer: PHCS Commercial |
$5,955.21
|
| Rate for Payer: United Healthcare All Payer |
$5,458.94
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,240.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,776.75
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVAL OF NERVE LESION
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.01 |
| Max. Negotiated Rate |
$1,703.41 |
| Rate for Payer: Aetna Commercial |
$1,703.41
|
| Rate for Payer: Ambetter Exchange |
$1,026.73
|
| Rate for Payer: Anthem Medicaid |
$704.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.08
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,520.66
|
| Rate for Payer: Healthspan PPO |
$1,329.98
|
| Rate for Payer: Humana Medicaid |
$704.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.09
|
| Rate for Payer: Molina Healthcare Passport |
$704.01
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.75
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.73
|
|
|
REMOVAL OF NERVE LESION
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
76102370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.54 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem Medicaid |
$885.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$894.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$903.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,240.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,776.75
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVAL OF NERVE LESION(P
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 64792
|
| Hospital Charge Code |
761P2370
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.01 |
| Max. Negotiated Rate |
$1,703.41 |
| Rate for Payer: Aetna Commercial |
$1,703.41
|
| Rate for Payer: Ambetter Exchange |
$1,026.73
|
| Rate for Payer: Anthem Medicaid |
$704.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,232.08
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,520.66
|
| Rate for Payer: Healthspan PPO |
$1,329.98
|
| Rate for Payer: Humana Medicaid |
$704.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,480.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.09
|
| Rate for Payer: Molina Healthcare Passport |
$704.01
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,334.75
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.73
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,086.41
|
| Rate for Payer: Ambetter Exchange |
$719.99
|
| Rate for Payer: Anthem Medicaid |
$422.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$719.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$719.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.99
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,055.58
|
| Rate for Payer: Healthspan PPO |
$1,051.92
|
| Rate for Payer: Humana Medicaid |
$422.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$719.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.15
|
| Rate for Payer: Molina Healthcare Passport |
$422.70
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$935.99
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$719.99
|
|
|
REMOVAL OF OVARY/TUBE(S)
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
76102256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REMOVAL OF OVARY/TUBE(S)(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 58720
|
| Hospital Charge Code |
761P2256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,086.41
|
| Rate for Payer: Ambetter Exchange |
$719.99
|
| Rate for Payer: Anthem Medicaid |
$422.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$719.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$719.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.99
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,055.58
|
| Rate for Payer: Healthspan PPO |
$1,051.92
|
| Rate for Payer: Humana Medicaid |
$422.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$937.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$719.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$431.15
|
| Rate for Payer: Molina Healthcare Passport |
$422.70
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$935.99
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$719.99
|
|
|
REMOVAL OF PACEMAKER
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
