|
REMOVAL OF PACEMAKER
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$10,705.58 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$325.00
|
| 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: Humana KY Medicaid |
$223.53
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| 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 |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| 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
|
|
|
REMOVAL OF PACEMAKER
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
76101263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$411.29 |
| Rate for Payer: Aetna Commercial |
$411.29
|
| Rate for Payer: Ambetter Exchange |
$216.35
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.62
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$403.27
|
| Rate for Payer: Healthspan PPO |
$404.38
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.25
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.35
|
|
|
REMOVAL OF PACEMAKER(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 33233
|
| Hospital Charge Code |
761P1263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$411.29 |
| Rate for Payer: Aetna Commercial |
$411.29
|
| Rate for Payer: Ambetter Exchange |
$216.35
|
| Rate for Payer: Anthem Medicaid |
$159.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$259.62
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$403.27
|
| Rate for Payer: Healthspan PPO |
$404.38
|
| Rate for Payer: Humana Medicaid |
$159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.35
|
| Rate for Payer: Molina Healthcare Passport |
$159.17
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$281.25
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.35
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Facility
|
OP
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$699.15 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Aetna Commercial |
$1,565.41
|
| Rate for Payer: Anthem Medicaid |
$699.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$1,687.39
|
| Rate for Payer: First Health Commercial |
$1,931.35
|
| Rate for Payer: Humana Commercial |
$1,728.05
|
| Rate for Payer: Humana KY Medicaid |
$699.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,362.64
|
| Rate for Payer: Kentucky WC Medicaid |
$706.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,035.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.77
|
| Rate for Payer: PHCS Commercial |
$1,951.68
|
| Rate for Payer: United Healthcare All Payer |
$1,789.04
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Facility
|
IP
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$609.90 |
| Max. Negotiated Rate |
$1,951.68 |
| Rate for Payer: Aetna Commercial |
$1,565.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.74
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$1,687.39
|
| Rate for Payer: First Health Commercial |
$1,931.35
|
| Rate for Payer: Humana Commercial |
$1,728.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,667.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,500.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,789.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.77
|
| Rate for Payer: PHCS Commercial |
$1,951.68
|
| Rate for Payer: United Healthcare All Payer |
$1,789.04
|
|
|
REMOVAL OF PACEMAKER SYSTEM
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
76101264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.36 |
| Max. Negotiated Rate |
$1,219.80 |
| Rate for Payer: Aetna Commercial |
$841.25
|
| Rate for Payer: Ambetter Exchange |
$451.45
|
| Rate for Payer: Anthem Medicaid |
$391.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$451.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$451.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$541.74
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$792.05
|
| Rate for Payer: Healthspan PPO |
$827.12
|
| Rate for Payer: Humana Medicaid |
$391.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$451.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.19
|
| Rate for Payer: Molina Healthcare Passport |
$391.36
|
| Rate for Payer: Multiplan PHCS |
$1,219.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.88
|
| Rate for Payer: UHCCP Medicaid |
$711.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$451.45
|
|
|
REMOVAL OF PACEMAKER SYSTEM(P
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 33234
|
| Hospital Charge Code |
761P1264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.36 |
| Max. Negotiated Rate |
$1,219.80 |
| Rate for Payer: Aetna Commercial |
$841.25
|
| Rate for Payer: Ambetter Exchange |
$451.45
|
| Rate for Payer: Anthem Medicaid |
$391.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$451.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$451.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$541.74
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cash Price |
$1,016.50
|
| Rate for Payer: Cigna Commercial |
$792.05
|
| Rate for Payer: Healthspan PPO |
$827.12
|
| Rate for Payer: Humana Medicaid |
$391.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$451.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.19
|
| Rate for Payer: Molina Healthcare Passport |
$391.36
|
| Rate for Payer: Multiplan PHCS |
$1,219.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.88
|
| Rate for Payer: UHCCP Medicaid |
$711.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$451.45
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.50 |
| Max. Negotiated Rate |
$580.80 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.45
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
REMOVAL OF PALM TENDON EACH
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.06 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$465.85
|
| Rate for Payer: Anthem Medicaid |
$208.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$471.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$502.15
|
| Rate for Payer: First Health Commercial |
$574.75
|
| Rate for Payer: Humana Commercial |
$514.25
|
| Rate for Payer: Humana KY Medicaid |
$208.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$210.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$496.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$446.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$212.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$532.40
|
| Rate for Payer: Ohio Health Group HMO |
$453.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.45
|
| Rate for Payer: PHCS Commercial |
$580.80
|
| Rate for Payer: United Healthcare All Payer |
$532.40
|
|
|
REMOVAL OF PALM TENDON EACH
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
76100679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$633.68 |
| Rate for Payer: Aetna Commercial |
$571.43
|
| Rate for Payer: Ambetter Exchange |
$390.71
|
| Rate for Payer: Anthem Medicaid |
$222.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$390.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$390.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$468.85
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$633.68
|
| Rate for Payer: Healthspan PPO |
$517.59
|
| Rate for Payer: Humana Medicaid |
$222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$494.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$390.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.86
|
| Rate for Payer: Molina Healthcare Passport |
$222.41
|
| Rate for Payer: Multiplan PHCS |
$363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.92
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$390.71
|
|
|
REMOVAL OF PALM TENDON EACH(P
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 26170
|
| Hospital Charge Code |
761P0679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$633.68 |
| Rate for Payer: Aetna Commercial |
$571.43
|
| Rate for Payer: Ambetter Exchange |
$390.71
|
| Rate for Payer: Anthem Medicaid |
$222.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$390.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$390.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$468.85
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cash Price |
$302.50
|
| Rate for Payer: Cigna Commercial |
$633.68
|
| Rate for Payer: Healthspan PPO |
$517.59
|
| Rate for Payer: Humana Medicaid |
$222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$494.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$390.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$226.86
|
| Rate for Payer: Molina Healthcare Passport |
$222.41
|
| Rate for Payer: Multiplan PHCS |
$363.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.92
|
| Rate for Payer: UHCCP Medicaid |
$211.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$224.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$390.71
|
|
|
REMOVAL OF PERITONEAL SHUNT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REMOVAL OF PERITONEAL SHUNT
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
REMOVAL OF PERITONEAL SHUNT
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
76102004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.09 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$673.78
|
| Rate for Payer: Ambetter Exchange |
$437.04
|
| Rate for Payer: Anthem Medicaid |
$294.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$437.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$437.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$524.45
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$633.53
|
| Rate for Payer: Healthspan PPO |
$568.22
|
| Rate for Payer: Humana Medicaid |
$294.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$437.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$437.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.97
|
| Rate for Payer: Molina Healthcare Passport |
$294.09
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$568.15
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$437.04
|
|
|
REMOVAL OF PERITONEAL SHUNT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 49429
|
| Hospital Charge Code |
761P2004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.09 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$673.78
|
| Rate for Payer: Ambetter Exchange |
$437.04
|
| Rate for Payer: Anthem Medicaid |
$294.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$437.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$437.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$524.45
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$633.53
|
| Rate for Payer: Healthspan PPO |
$568.22
|
| Rate for Payer: Humana Medicaid |
$294.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$587.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$437.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$437.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.97
|
| Rate for Payer: Molina Healthcare Passport |
$294.09
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$568.15
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$437.04
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR ONLY
|
Facility
|
OP
|
$10,705.58
|
|
|
Service Code
|
CPT 33233
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,646.84 |
| Max. Negotiated Rate |
$10,705.58 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; DUAL LEAD SYSTEM
|
Facility
|
OP
|
$13,537.66
|
|
|
Service Code
|
CPT 33228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,669.76 |
| Max. Negotiated Rate |
$13,537.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,669.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,537.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,054.18
|
| Rate for Payer: Humana Medicare Advantage |
$9,669.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,603.71
|
|
|
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; MULTIPLE LEAD SYSTEM
|
Facility
|
OP
|
$24,669.92
|
|
|
Service Code
|
CPT 33229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,621.37 |
| Max. Negotiated Rate |
$24,669.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,621.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,669.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$23,788.85
|
| Rate for Payer: Humana Medicare Advantage |
$17,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,145.64
|
|
|
REMOVAL OF RIB
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF RIB
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.30 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Ambetter Exchange |
$593.77
|
| Rate for Payer: Anthem Medicaid |
$584.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$593.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$593.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$712.52
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,109.28
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$584.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$593.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.99
|
| Rate for Payer: Molina Healthcare Passport |
$584.30
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$771.90
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$593.77
|
|
|
REMOVAL OF RIB
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REMOVAL OF RIB(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 21615
|
| Hospital Charge Code |
761P0400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.30 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Ambetter Exchange |
$593.77
|
| Rate for Payer: Anthem Medicaid |
$584.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$593.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$593.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$712.52
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,109.28
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$584.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$841.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$593.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.99
|
| Rate for Payer: Molina Healthcare Passport |
$584.30
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$771.90
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$593.77
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
76101682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$372.46
|
| Rate for Payer: Ambetter Exchange |
$249.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.07
|
| Rate for Payer: Anthem Medicaid |
$167.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$249.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$249.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$298.80
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$370.66
|
| Rate for Payer: Healthspan PPO |
$430.56
|
| Rate for Payer: Humana Medicaid |
$167.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$331.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$249.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.34
|
| Rate for Payer: Molina Healthcare Passport |
$167.00
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$323.70
|
| Rate for Payer: UHCCP Medicaid |
$175.42
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$249.00
|
|
