|
REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF SALIVARY STONE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.81 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$492.06
|
| Rate for Payer: Ambetter Exchange |
$325.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.81
|
| Rate for Payer: Anthem Medicaid |
$256.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.42
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$489.80
|
| Rate for Payer: Healthspan PPO |
$544.05
|
| Rate for Payer: Humana Medicaid |
$256.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$325.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.21
|
| Rate for Payer: Molina Healthcare Passport |
$256.09
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.95
|
| Rate for Payer: UHCCP Medicaid |
$261.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.35
|
|
|
REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
76101683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.49 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| 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 |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
REMOVAL OF SALIVARY STONE(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 42335
|
| Hospital Charge Code |
761P1682
|
|
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
|
|
|
REMOVAL OF SALIVARY STONE(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 42340
|
| Hospital Charge Code |
761P1683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.81 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$492.06
|
| Rate for Payer: Ambetter Exchange |
$325.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$248.81
|
| Rate for Payer: Anthem Medicaid |
$256.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.42
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$489.80
|
| Rate for Payer: Healthspan PPO |
$544.05
|
| Rate for Payer: Humana Medicaid |
$256.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$325.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$261.21
|
| Rate for Payer: Molina Healthcare Passport |
$256.09
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.95
|
| Rate for Payer: UHCCP Medicaid |
$261.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$258.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.35
|
|
|
REMOVAL OF SESAMOID BONE
|
Professional
|
Both
|
$5,855.00
|
|
|
Service Code
|
HCPCS 28315
|
| Hospital Charge Code |
76102659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$3,513.00 |
| Rate for Payer: Aetna Commercial |
$500.10
|
| Rate for Payer: Ambetter Exchange |
$310.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.46
|
| Rate for Payer: Anthem Medicaid |
$258.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.59
|
| Rate for Payer: Cash Price |
$2,927.50
|
| Rate for Payer: Cash Price |
$2,927.50
|
| Rate for Payer: Cigna Commercial |
$542.32
|
| Rate for Payer: Healthspan PPO |
$591.63
|
| Rate for Payer: Humana Medicaid |
$258.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.84
|
| Rate for Payer: Molina Healthcare Passport |
$258.67
|
| Rate for Payer: Multiplan PHCS |
$3,513.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.64
|
| Rate for Payer: UHCCP Medicaid |
$174.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.49
|
|
|
REMOVAL OF SINGLE OR DUAL CHAMBER IMPLANTABLE DEFIBRILLATOR ELECTRODE(S); BY TRANSVENOUS EXTRACTION
|
Facility
|
OP
|
$4,707.70
|
|
|
Service Code
|
CPT 33244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,362.64 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,707.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,539.56
|
| Rate for Payer: Humana Medicare Advantage |
$3,362.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,035.17
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$257.03
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
|
|
REMOVAL OF SKULL LESION
|
Facility
|
IP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,510.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$3,735.00
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Humana Commercial |
$3,825.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,690.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,321.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,960.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,915.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,105.00
|
| Rate for Payer: PHCS Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Payer |
$3,960.00
|
|
|
REMOVAL OF SKULL LESION
|
Facility
|
OP
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$3,465.00
|
| Rate for Payer: Anthem Medicaid |
$1,547.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,510.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$3,735.00
|
| Rate for Payer: First Health Commercial |
$4,275.00
|
| Rate for Payer: Humana Commercial |
$3,825.00
|
| Rate for Payer: Humana KY Medicaid |
$1,547.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,690.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,321.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,960.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,915.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,105.00
|
| Rate for Payer: PHCS Commercial |
$4,320.00
|
| Rate for Payer: United Healthcare All Payer |
$3,960.00
|
|
|
REMOVAL OF SKULL LESION
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
76102285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.09 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,137.34
|
| Rate for Payer: Ambetter Exchange |
$1,240.19
|
| Rate for Payer: Anthem Medicaid |
$1,122.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,240.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,488.23
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$1,919.27
|
| Rate for Payer: Healthspan PPO |
$1,668.78
|
| Rate for Payer: Humana Medicaid |
$1,122.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,737.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,240.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.53
|
| Rate for Payer: Molina Healthcare Passport |
$1,122.09
|
| Rate for Payer: Multiplan PHCS |
$2,700.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,612.25
|
| Rate for Payer: UHCCP Medicaid |
$1,575.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,240.19
|
|
|
REMOVAL OF SKULL LESION(P
|
Professional
|
Both
|
$4,500.00
|
|
|
Service Code
|
HCPCS 61500
|
| Hospital Charge Code |
761P2285
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.09 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$2,137.34
|
| Rate for Payer: Ambetter Exchange |
$1,240.19
|
| Rate for Payer: Anthem Medicaid |
$1,122.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,240.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,488.23
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna Commercial |
$1,919.27
|
| Rate for Payer: Healthspan PPO |
$1,668.78
|
| Rate for Payer: Humana Medicaid |
$1,122.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,737.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,240.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,144.53
|
| Rate for Payer: Molina Healthcare Passport |
$1,122.09
|
| Rate for Payer: Multiplan PHCS |
$2,700.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,612.25
|
| Rate for Payer: UHCCP Medicaid |
$1,575.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,133.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,240.19
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
76101812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
REMOVAL OF SMALL INTESTINE
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
76101812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.61 |
| Max. Negotiated Rate |
$1,705.00 |
| Rate for Payer: Aetna Commercial |
$1,705.00
|
| Rate for Payer: Ambetter Exchange |
$1,118.73
|
| Rate for Payer: Anthem Medicaid |
$729.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,118.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,342.48
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,584.81
|
| Rate for Payer: Healthspan PPO |
$1,437.86
|
| Rate for Payer: Humana Medicaid |
$729.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,506.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,118.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.20
|
| Rate for Payer: Molina Healthcare Passport |
$729.61
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,454.35
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,118.73
|
|
|
REMOVAL OF SMALL INTESTINE
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
76101812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
REMOVAL OF SMALL INTESTINE(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 44125
|
| Hospital Charge Code |
761P1812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.61 |
| Max. Negotiated Rate |
$1,705.00 |
| Rate for Payer: Aetna Commercial |
$1,705.00
|
| Rate for Payer: Ambetter Exchange |
$1,118.73
|
| Rate for Payer: Anthem Medicaid |
$729.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,118.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,342.48
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,584.81
|
| Rate for Payer: Healthspan PPO |
$1,437.86
|
| Rate for Payer: Humana Medicaid |
$729.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,506.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,118.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.20
|
| Rate for Payer: Molina Healthcare Passport |
$729.61
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,454.35
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,118.73
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Professional
|
Both
|
$4,409.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$2,645.40 |
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Ambetter Exchange |
$217.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.42
|
| Rate for Payer: Anthem Medicaid |
$171.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$217.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$260.71
|
| Rate for Payer: Cash Price |
$2,204.50
|
| Rate for Payer: Cash Price |
$2,204.50
|
| Rate for Payer: Cigna Commercial |
$771.35
|
| Rate for Payer: Healthspan PPO |
$653.67
|
| Rate for Payer: Humana Medicaid |
$171.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$217.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.97
|
| Rate for Payer: Molina Healthcare Passport |
$171.54
|
| Rate for Payer: Multiplan PHCS |
$2,645.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.44
|
| Rate for Payer: UHCCP Medicaid |
$170.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.26
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
OP
|
$4,409.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,516.26 |
| Max. Negotiated Rate |
$4,232.64 |
| Rate for Payer: Aetna Commercial |
$3,394.93
|
| Rate for Payer: Anthem Medicaid |
$1,516.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,439.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,204.50
|
| Rate for Payer: Cash Price |
$2,204.50
|
| Rate for Payer: Cigna Commercial |
$3,659.47
|
| Rate for Payer: First Health Commercial |
$4,188.55
|
| Rate for Payer: Humana Commercial |
$3,747.65
|
| Rate for Payer: Humana KY Medicaid |
$1,516.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,531.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,615.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,253.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,546.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,879.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,527.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,835.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,042.21
|
| Rate for Payer: PHCS Commercial |
$4,232.64
|
| Rate for Payer: United Healthcare All Payer |
$3,879.92
|
|
|
REMOVAL OF SPERM DUCT(S)
|
Facility
|
IP
|
$4,409.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
76102148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,322.70 |
| Max. Negotiated Rate |
$4,232.64 |
| Rate for Payer: Aetna Commercial |
$3,394.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,439.02
|
| Rate for Payer: Cash Price |
$2,204.50
|
| Rate for Payer: Cigna Commercial |
$3,659.47
|
| Rate for Payer: First Health Commercial |
$4,188.55
|
| Rate for Payer: Humana Commercial |
$3,747.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,615.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,253.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,879.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,306.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,527.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,835.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,042.21
|
| Rate for Payer: PHCS Commercial |
$4,232.64
|
| Rate for Payer: United Healthcare All Payer |
$3,879.92
|
|
|
REMOVAL OF SPERM DUCT(S)(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761P2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$771.35 |
| Rate for Payer: Aetna Commercial |
$364.14
|
| Rate for Payer: Ambetter Exchange |
$217.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.42
|
| Rate for Payer: Anthem Medicaid |
$171.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$217.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$260.71
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$771.35
|
| Rate for Payer: Healthspan PPO |
$653.67
|
| Rate for Payer: Humana Medicaid |
$171.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$217.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.97
|
| Rate for Payer: Molina Healthcare Passport |
$171.54
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.44
|
| Rate for Payer: UHCCP Medicaid |
$170.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.26
|
|
|
REMOVAL OF SPERM DUCT(S)(T
|
Facility
|
OP
|
$3,859.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761T2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,327.11 |
| Max. Negotiated Rate |
$3,704.64 |
| Rate for Payer: Aetna Commercial |
$2,971.43
|
| Rate for Payer: Anthem Medicaid |
$1,327.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,010.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$1,929.50
|
| Rate for Payer: Cash Price |
$1,929.50
|
| Rate for Payer: Cigna Commercial |
$3,202.97
|
| Rate for Payer: First Health Commercial |
$3,666.05
|
| Rate for Payer: Humana Commercial |
$3,280.15
|
| Rate for Payer: Humana KY Medicaid |
$1,327.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,340.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,164.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,847.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,395.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,894.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,357.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,662.71
|
| Rate for Payer: PHCS Commercial |
$3,704.64
|
| Rate for Payer: United Healthcare All Payer |
$3,395.92
|
|
|
REMOVAL OF SPERM DUCT(S)(T
|
Facility
|
IP
|
$3,859.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
761T2148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,157.70 |
| Max. Negotiated Rate |
$3,704.64 |
| Rate for Payer: Aetna Commercial |
$2,971.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,010.02
|
| Rate for Payer: Cash Price |
$1,929.50
|
| Rate for Payer: Cigna Commercial |
$3,202.97
|
| Rate for Payer: First Health Commercial |
$3,666.05
|
| Rate for Payer: Humana Commercial |
$3,280.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,164.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,847.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,395.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,894.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,357.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,662.71
|
| Rate for Payer: PHCS Commercial |
$3,704.64
|
| Rate for Payer: United Healthcare All Payer |
$3,395.92
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,644.06 |
| Rate for Payer: Aetna Commercial |
$1,644.06
|
| Rate for Payer: Ambetter Exchange |
$1,110.62
|
| Rate for Payer: Anthem Medicaid |
$593.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,110.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,110.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,332.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,520.51
|
| Rate for Payer: Healthspan PPO |
$1,314.57
|
| Rate for Payer: Humana Medicaid |
$593.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,478.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,110.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$605.48
|
| Rate for Payer: Molina Healthcare Passport |
$593.61
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,443.81
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$599.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,110.62
|
|
|
REMOVAL OF SPLEEN PARTIAL
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
76101586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
