|
REMOVAL OF SPLEEN PARTIAL(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 38101
|
| Hospital Charge Code |
761P1586
|
|
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 STOMACH PARTIAL
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Ambetter Exchange |
$106.99
|
| Rate for Payer: Anthem Medicaid |
$95.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.39
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$160.92
|
| Rate for Payer: Healthspan PPO |
$143.13
|
| Rate for Payer: Humana Medicaid |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.64
|
| Rate for Payer: Molina Healthcare Passport |
$95.73
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.09
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.99
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 43633
|
| Hospital Charge Code |
76102643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$768.25 |
| Max. Negotiated Rate |
$2,702.63 |
| Rate for Payer: Aetna Commercial |
$2,702.63
|
| Rate for Payer: Ambetter Exchange |
$1,834.41
|
| Rate for Payer: Anthem Medicaid |
$941.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,834.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,834.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,201.29
|
| Rate for Payer: Cash Price |
$1,097.50
|
| Rate for Payer: Cash Price |
$1,097.50
|
| Rate for Payer: Cigna Commercial |
$2,461.75
|
| Rate for Payer: Healthspan PPO |
$2,279.18
|
| Rate for Payer: Humana Medicaid |
$941.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,448.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,834.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,834.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$960.63
|
| Rate for Payer: Molina Healthcare Passport |
$941.79
|
| Rate for Payer: Multiplan PHCS |
$1,317.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,384.73
|
| Rate for Payer: UHCCP Medicaid |
$768.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$951.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,834.41
|
|
|
REMOVAL OF STOMACH PARTIAL
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
76101786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
REMOVAL OF STOMACH PARTIAL(P
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 43635
|
| Hospital Charge Code |
761P1786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$169.72
|
| Rate for Payer: Ambetter Exchange |
$106.99
|
| Rate for Payer: Anthem Medicaid |
$95.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.39
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$160.92
|
| Rate for Payer: Healthspan PPO |
$143.13
|
| Rate for Payer: Humana Medicaid |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.64
|
| Rate for Payer: Molina Healthcare Passport |
$95.73
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$139.09
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.99
|
|
|
REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS, OPEN
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 23000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
REMOVAL OF SUBSTERNAL IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Facility
|
OP
|
$4,707.70
|
|
|
Service Code
|
CPT 0573T
|
|
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 SUBSTERNAL IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR ONLY
|
Facility
|
OP
|
$4,707.70
|
|
|
Service Code
|
CPT 0580T
|
|
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 SUPPORT IMPLANT
|
Facility
|
IP
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,220.30 |
| Max. Negotiated Rate |
$7,104.96 |
| Rate for Payer: Aetna Commercial |
$5,698.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.78
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$6,142.83
|
| Rate for Payer: First Health Commercial |
$7,030.95
|
| Rate for Payer: Humana Commercial |
$6,290.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,220.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,438.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,106.69
|
| Rate for Payer: PHCS Commercial |
$7,104.96
|
| Rate for Payer: United Healthcare All Payer |
$6,512.88
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Facility
|
OP
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,545.20 |
| Max. Negotiated Rate |
$7,104.96 |
| Rate for Payer: Aetna Commercial |
$5,698.77
|
| Rate for Payer: Anthem Medicaid |
$2,545.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$6,142.83
|
| Rate for Payer: First Health Commercial |
$7,030.95
|
| Rate for Payer: Humana Commercial |
$6,290.85
|
| Rate for Payer: Humana KY Medicaid |
$2,545.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,571.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,596.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.88
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,920.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,438.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,106.69
|
| Rate for Payer: PHCS Commercial |
$7,104.96
|
| Rate for Payer: United Healthcare All Payer |
$6,512.88
|
|
|
REMOVAL OF SUPPORT IMPLANT
|
Professional
|
Both
|
$7,401.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
76100350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.08 |
| Max. Negotiated Rate |
$4,440.60 |
| Rate for Payer: Aetna Commercial |
$596.71
|
| Rate for Payer: Ambetter Exchange |
$398.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.39
|
| Rate for Payer: Anthem Medicaid |
$197.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$478.09
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cash Price |
$3,700.50
|
| Rate for Payer: Cigna Commercial |
$628.39
|
| Rate for Payer: Healthspan PPO |
$745.55
|
| Rate for Payer: Humana Medicaid |
$197.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.02
|
| Rate for Payer: Molina Healthcare Passport |
$197.08
|
| Rate for Payer: Multiplan PHCS |
$4,440.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.93
|
| Rate for Payer: UHCCP Medicaid |
$225.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.41
|
|
|
REMOVAL OF SUPPORT IMPLANT(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
761P0350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.08 |
| Max. Negotiated Rate |
$745.55 |
| Rate for Payer: Aetna Commercial |
$596.71
|
| Rate for Payer: Ambetter Exchange |
$398.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.39
|
| Rate for Payer: Anthem Medicaid |
$197.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$478.09
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$628.39
|
| Rate for Payer: Healthspan PPO |
$745.55
|
| Rate for Payer: Humana Medicaid |
$197.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.02
|
| Rate for Payer: Molina Healthcare Passport |
$197.08
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.93
|
| Rate for Payer: UHCCP Medicaid |
$225.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.41
|
|
|
REMOVAL OF SUPPORT IMPLANT(T
|
Facility
|
IP
|
$6,501.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
761T0350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,950.30 |
| Max. Negotiated Rate |
$6,240.96 |
| Rate for Payer: Aetna Commercial |
$5,005.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,070.78
|
| Rate for Payer: Cash Price |
$3,250.50
|
| Rate for Payer: Cigna Commercial |
$5,395.83
|
| Rate for Payer: First Health Commercial |
$6,175.95
|
| Rate for Payer: Humana Commercial |
$5,525.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,330.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,797.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,950.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,720.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,875.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,655.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,485.69
|
| Rate for Payer: PHCS Commercial |
$6,240.96
|
| Rate for Payer: United Healthcare All Payer |
$5,720.88
|
|
|
REMOVAL OF SUPPORT IMPLANT(T
|
Facility
|
OP
|
$6,501.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
761T0350
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,235.69 |
| Max. Negotiated Rate |
$6,240.96 |
| Rate for Payer: Aetna Commercial |
$5,005.77
|
| Rate for Payer: Anthem Medicaid |
$2,235.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,070.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,250.50
|
| Rate for Payer: Cash Price |
$3,250.50
|
| Rate for Payer: Cigna Commercial |
$5,395.83
|
| Rate for Payer: First Health Commercial |
$6,175.95
|
| Rate for Payer: Humana Commercial |
$5,525.85
|
| Rate for Payer: Humana KY Medicaid |
$2,235.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,258.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,330.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,797.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,280.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,720.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,875.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,200.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,655.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,485.69
|
| Rate for Payer: PHCS Commercial |
$6,240.96
|
| Rate for Payer: United Healthcare All Payer |
$5,720.88
|
|
|
REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 15851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
REMOVAL OF TENDON FOR GRAFT
|
Facility
|
OP
|
$9,544.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,282.18 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$7,348.88
|
| Rate for Payer: Anthem Medicaid |
$3,282.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,444.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,772.00
|
| Rate for Payer: Cash Price |
$4,772.00
|
| Rate for Payer: Cigna Commercial |
$7,921.52
|
| Rate for Payer: First Health Commercial |
$9,066.80
|
| Rate for Payer: Humana Commercial |
$8,112.40
|
| Rate for Payer: Humana KY Medicaid |
$3,282.18
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,315.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,826.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,043.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,348.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,398.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,303.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,585.36
|
| Rate for Payer: PHCS Commercial |
$9,162.24
|
| Rate for Payer: United Healthcare All Payer |
$8,398.72
|
|
|
REMOVAL OF TENDON FOR GRAFT
|
Professional
|
Both
|
$9,544.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.07 |
| Max. Negotiated Rate |
$5,726.40 |
| Rate for Payer: Aetna Commercial |
$739.19
|
| Rate for Payer: Ambetter Exchange |
$480.24
|
| Rate for Payer: Anthem Medicaid |
$344.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$480.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$576.29
|
| Rate for Payer: Cash Price |
$4,772.00
|
| Rate for Payer: Cash Price |
$4,772.00
|
| Rate for Payer: Cigna Commercial |
$815.86
|
| Rate for Payer: Healthspan PPO |
$669.55
|
| Rate for Payer: Humana Medicaid |
$344.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$624.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$480.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.95
|
| Rate for Payer: Molina Healthcare Passport |
$344.07
|
| Rate for Payer: Multiplan PHCS |
$5,726.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$624.31
|
| Rate for Payer: UHCCP Medicaid |
$3,340.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$480.24
|
|
|
REMOVAL OF TENDON FOR GRAFT
|
Facility
|
IP
|
$9,544.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,863.20 |
| Max. Negotiated Rate |
$9,162.24 |
| Rate for Payer: Aetna Commercial |
$7,348.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,444.32
|
| Rate for Payer: Cash Price |
$4,772.00
|
| Rate for Payer: Cigna Commercial |
$7,921.52
|
| Rate for Payer: First Health Commercial |
$9,066.80
|
| Rate for Payer: Humana Commercial |
$8,112.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,826.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,043.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,863.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,398.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,635.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,303.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,585.36
|
| Rate for Payer: PHCS Commercial |
$9,162.24
|
| Rate for Payer: United Healthcare All Payer |
$8,398.72
|
|
|
REMOVAL OF TENDON FOR GRAFT(P
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
761P0357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$815.86 |
| Rate for Payer: Aetna Commercial |
$739.19
|
| Rate for Payer: Ambetter Exchange |
$480.24
|
| Rate for Payer: Anthem Medicaid |
$344.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$480.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$576.29
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cash Price |
$488.00
|
| Rate for Payer: Cigna Commercial |
$815.86
|
| Rate for Payer: Healthspan PPO |
$669.55
|
| Rate for Payer: Humana Medicaid |
$344.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$624.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$480.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.95
|
| Rate for Payer: Molina Healthcare Passport |
$344.07
|
| Rate for Payer: Multiplan PHCS |
$585.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$624.31
|
| Rate for Payer: UHCCP Medicaid |
$341.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$347.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$480.24
|
|
|
REMOVAL OF TENDON FOR GRAFT(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
761T0357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF TENDON FOR GRAFT(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20924
|
| Hospital Charge Code |
761T0357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
REMOVAL OF TESTIS
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
76102137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.72 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Aetna Commercial |
$530.82
|
| Rate for Payer: Ambetter Exchange |
$311.26
|
| Rate for Payer: Anthem Medicaid |
$299.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$311.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$311.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$373.51
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$474.10
|
| Rate for Payer: Healthspan PPO |
$513.96
|
| Rate for Payer: Humana Medicaid |
$299.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$444.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$311.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$311.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.71
|
| Rate for Payer: Molina Healthcare Passport |
$299.72
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$404.64
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$311.26
|
|
|
REMOVAL OF TESTIS
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
76102137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
REMOVAL OF TESTIS
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
76102138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem Medicaid |
$472.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Humana KY Medicaid |
$472.86
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$477.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.75
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
