|
REQUIP(ROPINIROLE)1MG TAB
|
Facility
|
OP
|
$4.78
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
25001315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
REQUIP(ROPINIROLE)1MG TAB
|
Facility
|
IP
|
$4.78
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
25001315
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.73
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna Commercial |
$3.97
|
| Rate for Payer: First Health Commercial |
$4.54
|
| Rate for Payer: Humana Commercial |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.21
|
| Rate for Payer: Ohio Health Group HMO |
$3.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Payer |
$4.21
|
|
|
REQUIP(ROPINIROLE)2MG TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68462025601
|
| Hospital Charge Code |
25001316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
REQUIP(ROPINIROLE)2MG TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68462025601
|
| Hospital Charge Code |
25001316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
REREMOVE WRIST TENDON LESION
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$548.65
|
| Rate for Payer: Anthem Medicaid |
$244.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$636.47
|
| Rate for Payer: Healthspan PPO |
$496.96
|
| Rate for Payer: Humana Medicaid |
$244.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$471.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.23
|
| Rate for Payer: Molina Healthcare Passport |
$244.34
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$616.00
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.78
|
|
|
REREMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem Medicaid |
$302.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Humana KY Medicaid |
$302.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$305.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.80
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
REREMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
76100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$844.80 |
| Rate for Payer: Aetna Commercial |
$677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$686.40
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$730.40
|
| Rate for Payer: First Health Commercial |
$836.00
|
| Rate for Payer: Humana Commercial |
$748.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$721.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$649.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$774.40
|
| Rate for Payer: Ohio Health Group HMO |
$660.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.80
|
| Rate for Payer: PHCS Commercial |
$844.80
|
| Rate for Payer: United Healthcare All Payer |
$774.40
|
|
|
REREMOVE WRIST TENDON LESIO(P
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS 25112
|
| Hospital Charge Code |
761P0583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.34 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$548.65
|
| Rate for Payer: Anthem Medicaid |
$244.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cigna Commercial |
$636.47
|
| Rate for Payer: Healthspan PPO |
$496.96
|
| Rate for Payer: Humana Medicaid |
$244.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$471.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$249.23
|
| Rate for Payer: Molina Healthcare Passport |
$244.34
|
| Rate for Payer: Multiplan PHCS |
$528.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$616.00
|
| Rate for Payer: UHCCP Medicaid |
$308.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.78
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
OP
|
$8,318.34
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.38 |
| Max. Negotiated Rate |
$7,985.61 |
| Rate for Payer: Aetna Commercial |
$6,405.12
|
| Rate for Payer: Anthem Medicaid |
$2,860.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$4,159.17
|
| Rate for Payer: Cash Price |
$4,159.17
|
| Rate for Payer: Cigna Commercial |
$6,904.22
|
| Rate for Payer: First Health Commercial |
$7,902.42
|
| Rate for Payer: Humana Commercial |
$7,070.59
|
| Rate for Payer: Humana KY Medicaid |
$2,860.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,821.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,918.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,320.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,238.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,578.69
|
| Rate for Payer: PHCS Commercial |
$7,985.61
|
| Rate for Payer: United Healthcare All Payer |
$7,320.14
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Facility
|
IP
|
$8,318.34
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.38 |
| Max. Negotiated Rate |
$7,985.61 |
| Rate for Payer: Aetna Commercial |
$6,405.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.31
|
| Rate for Payer: Cash Price |
$4,159.17
|
| Rate for Payer: Cigna Commercial |
$6,904.22
|
| Rate for Payer: First Health Commercial |
$7,902.42
|
| Rate for Payer: Humana Commercial |
$7,070.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,821.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,320.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,238.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,081.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,578.69
|
| Rate for Payer: PHCS Commercial |
$7,985.61
|
| Rate for Payer: United Healthcare All Payer |
$7,320.14
|
|
|
RESECT ARM/ELBOW TUM < 5 CM
|
Professional
|
Both
|
$8,318.34
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.09 |
| Max. Negotiated Rate |
$8,318.34 |
| Rate for Payer: Aetna Commercial |
$1,196.76
|
| Rate for Payer: Anthem Medicaid |
$636.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,318.34
|
| Rate for Payer: Cash Price |
$4,159.17
|
| Rate for Payer: Cash Price |
$4,159.17
|
| Rate for Payer: Cigna Commercial |
$1,299.55
|
| Rate for Payer: Healthspan PPO |
$1,084.01
|
| Rate for Payer: Humana Medicaid |
$636.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,258.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$648.81
|
| Rate for Payer: Molina Healthcare Passport |
$636.09
|
| Rate for Payer: Multiplan PHCS |
$4,991.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,822.84
|
| Rate for Payer: UHCCP Medicaid |
$2,911.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.45
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,277.30 |
| Rate for Payer: Aetna Commercial |
$2,007.19
|
| Rate for Payer: Anthem Medicaid |
$940.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$2,277.30
|
| Rate for Payer: Healthspan PPO |
$1,431.90
|
| Rate for Payer: Humana Medicaid |
$940.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,640.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$959.01
|
| Rate for Payer: Molina Healthcare Passport |
$940.21
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$949.61
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(P
|
Professional
|
Both
|
$2,785.00
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761P0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.09 |
| Max. Negotiated Rate |
$2,785.00 |
| Rate for Payer: Aetna Commercial |
$1,196.76
|
| Rate for Payer: Anthem Medicaid |
$636.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,785.00
|
| Rate for Payer: Cash Price |
$1,392.50
|
| Rate for Payer: Cash Price |
$1,392.50
|
| Rate for Payer: Cigna Commercial |
$1,299.55
|
| Rate for Payer: Healthspan PPO |
$1,084.01
|
| Rate for Payer: Humana Medicaid |
$636.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,258.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$648.81
|
| Rate for Payer: Molina Healthcare Passport |
$636.09
|
| Rate for Payer: Multiplan PHCS |
$1,671.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,949.50
|
| Rate for Payer: UHCCP Medicaid |
$974.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$642.45
|
|
|
RESECT ARM/ELBOW TUM 5 CM/>(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24079
|
| Hospital Charge Code |
761P0505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,277.30 |
| Rate for Payer: Aetna Commercial |
$2,007.19
|
| Rate for Payer: Anthem Medicaid |
$940.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$2,277.30
|
| Rate for Payer: Healthspan PPO |
$1,431.90
|
| Rate for Payer: Humana Medicaid |
$940.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,640.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$959.01
|
| Rate for Payer: Molina Healthcare Passport |
$940.21
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$949.61
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(T
|
Facility
|
OP
|
$5,533.34
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761T0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$719.33 |
| Max. Negotiated Rate |
$5,312.01 |
| Rate for Payer: Aetna Commercial |
$4,260.67
|
| Rate for Payer: Anthem Medicaid |
$1,902.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,316.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,766.67
|
| Rate for Payer: Cash Price |
$2,766.67
|
| Rate for Payer: Cigna Commercial |
$4,592.67
|
| Rate for Payer: First Health Commercial |
$5,256.67
|
| Rate for Payer: Humana Commercial |
$4,703.34
|
| Rate for Payer: Humana KY Medicaid |
$1,902.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,922.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,537.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,083.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,869.34
|
| Rate for Payer: Ohio Health Group HMO |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,106.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.34
|
| Rate for Payer: PHCS Commercial |
$5,312.01
|
| Rate for Payer: United Healthcare All Payer |
$4,869.34
|
|
|
RESECT ARM/ELBOW TUM < 5 CM(T
|
Facility
|
IP
|
$5,533.34
|
|
|
Service Code
|
HCPCS 24077
|
| Hospital Charge Code |
761T0504
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$719.33 |
| Max. Negotiated Rate |
$5,312.01 |
| Rate for Payer: Aetna Commercial |
$4,260.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,316.01
|
| Rate for Payer: Cash Price |
$2,766.67
|
| Rate for Payer: Cigna Commercial |
$4,592.67
|
| Rate for Payer: First Health Commercial |
$5,256.67
|
| Rate for Payer: Humana Commercial |
$4,703.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,537.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,083.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,869.34
|
| Rate for Payer: Ohio Health Group HMO |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,106.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.34
|
| Rate for Payer: PHCS Commercial |
$5,312.01
|
| Rate for Payer: United Healthcare All Payer |
$4,869.34
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
IP
|
$8,055.68
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,047.24 |
| Max. Negotiated Rate |
$7,733.45 |
| Rate for Payer: Aetna Commercial |
$6,202.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.43
|
| Rate for Payer: Cash Price |
$4,027.84
|
| Rate for Payer: Cigna Commercial |
$6,686.21
|
| Rate for Payer: First Health Commercial |
$7,652.90
|
| Rate for Payer: Humana Commercial |
$6,847.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,416.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,041.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.26
|
| Rate for Payer: PHCS Commercial |
$7,733.45
|
| Rate for Payer: United Healthcare All Payer |
$7,089.00
|
|
|
RESECT BACK TUM < 5 CM
|
Facility
|
OP
|
$8,055.68
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,047.24 |
| Max. Negotiated Rate |
$7,733.45 |
| Rate for Payer: Aetna Commercial |
$6,202.87
|
| Rate for Payer: Anthem Medicaid |
$2,770.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,283.43
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$4,027.84
|
| Rate for Payer: Cash Price |
$4,027.84
|
| Rate for Payer: Cigna Commercial |
$6,686.21
|
| Rate for Payer: First Health Commercial |
$7,652.90
|
| Rate for Payer: Humana Commercial |
$6,847.33
|
| Rate for Payer: Humana KY Medicaid |
$2,770.35
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,798.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,605.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,945.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,825.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,089.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,041.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,047.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,497.26
|
| Rate for Payer: PHCS Commercial |
$7,733.45
|
| Rate for Payer: United Healthcare All Payer |
$7,089.00
|
|
|
RESECT BACK TUM < 5 CM
|
Professional
|
Both
|
$8,055.68
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
76100416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.71 |
| Max. Negotiated Rate |
$8,055.68 |
| Rate for Payer: Aetna Commercial |
$1,720.35
|
| Rate for Payer: Anthem Medicaid |
$710.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,055.68
|
| Rate for Payer: Cash Price |
$4,027.84
|
| Rate for Payer: Cash Price |
$4,027.84
|
| Rate for Payer: Cigna Commercial |
$1,846.19
|
| Rate for Payer: Healthspan PPO |
$1,558.27
|
| Rate for Payer: Humana Medicaid |
$710.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,296.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$724.92
|
| Rate for Payer: Molina Healthcare Passport |
$710.71
|
| Rate for Payer: Multiplan PHCS |
$4,833.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,638.98
|
| Rate for Payer: UHCCP Medicaid |
$2,819.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$717.82
|
|
|
RESECT BACK TUM 5 CM/>
|
Facility
|
OP
|
$9,840.54
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,279.27 |
| Max. Negotiated Rate |
$9,446.92 |
| Rate for Payer: Aetna Commercial |
$7,577.22
|
| Rate for Payer: Anthem Medicaid |
$3,384.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,675.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$4,920.27
|
| Rate for Payer: Cash Price |
$4,920.27
|
| Rate for Payer: Cigna Commercial |
$8,167.65
|
| Rate for Payer: First Health Commercial |
$9,348.51
|
| Rate for Payer: Humana Commercial |
$8,364.46
|
| Rate for Payer: Humana KY Medicaid |
$3,384.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,418.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,069.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,262.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,452.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,659.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,380.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,968.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,050.57
|
| Rate for Payer: PHCS Commercial |
$9,446.92
|
| Rate for Payer: United Healthcare All Payer |
$8,659.68
|
|
|
RESECT BACK TUM 5 CM/>
|
Professional
|
Both
|
$9,840.54
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,046.66 |
| Max. Negotiated Rate |
$9,840.54 |
| Rate for Payer: Aetna Commercial |
$2,229.11
|
| Rate for Payer: Anthem Medicaid |
$1,046.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,840.54
|
| Rate for Payer: Cash Price |
$4,920.27
|
| Rate for Payer: Cash Price |
$4,920.27
|
| Rate for Payer: Cigna Commercial |
$2,532.94
|
| Rate for Payer: Healthspan PPO |
$1,590.55
|
| Rate for Payer: Humana Medicaid |
$1,046.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,824.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,067.59
|
| Rate for Payer: Molina Healthcare Passport |
$1,046.66
|
| Rate for Payer: Multiplan PHCS |
$5,904.32
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,888.38
|
| Rate for Payer: UHCCP Medicaid |
$3,444.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,057.13
|
|
|
RESECT BACK TUM 5 CM/>
|
Facility
|
IP
|
$9,840.54
|
|
|
Service Code
|
HCPCS 21936
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,279.27 |
| Max. Negotiated Rate |
$9,446.92 |
| Rate for Payer: Aetna Commercial |
$7,577.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,675.62
|
| Rate for Payer: Cash Price |
$4,920.27
|
| Rate for Payer: Cigna Commercial |
$8,167.65
|
| Rate for Payer: First Health Commercial |
$9,348.51
|
| Rate for Payer: Humana Commercial |
$8,364.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,069.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,262.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,659.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,380.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,968.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,279.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,050.57
|
| Rate for Payer: PHCS Commercial |
$9,446.92
|
| Rate for Payer: United Healthcare All Payer |
$8,659.68
|
|
|
RESECT BACK TUM < 5 CM(P
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 21935
|
| Hospital Charge Code |
761P0416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.71 |
| Max. Negotiated Rate |
$2,114.00 |
| Rate for Payer: Aetna Commercial |
$1,720.35
|
| Rate for Payer: Anthem Medicaid |
$710.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,114.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cash Price |
$1,057.00
|
| Rate for Payer: Cigna Commercial |
$1,846.19
|
| Rate for Payer: Healthspan PPO |
$1,558.27
|
| Rate for Payer: Humana Medicaid |
$710.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,296.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$724.92
|
| Rate for Payer: Molina Healthcare Passport |
$710.71
|
| Rate for Payer: Multiplan PHCS |
$1,268.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,479.80
|
| Rate for Payer: UHCCP Medicaid |
$739.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$717.82
|
|
