|
REMOVAL OF TESTIS
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
76102138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.97 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$824.49
|
| Rate for Payer: Ambetter Exchange |
$482.67
|
| Rate for Payer: Anthem Medicaid |
$450.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.20
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$791.84
|
| Rate for Payer: Healthspan PPO |
$798.31
|
| Rate for Payer: Humana Medicaid |
$450.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.99
|
| Rate for Payer: Molina Healthcare Passport |
$450.97
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.47
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.67
|
|
|
REMOVAL OF TESTIS
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
76102137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$537.50
|
| 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: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$373.45
|
| 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 |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| 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
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
76102138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| 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: 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 |
$412.50
|
| 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
|
|
|
REMOVAL OF TESTIS(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 54520
|
| Hospital Charge Code |
761P2137
|
|
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(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 54530
|
| Hospital Charge Code |
761P2138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.97 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$824.49
|
| Rate for Payer: Ambetter Exchange |
$482.67
|
| Rate for Payer: Anthem Medicaid |
$450.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$579.20
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$791.84
|
| Rate for Payer: Healthspan PPO |
$798.31
|
| Rate for Payer: Humana Medicaid |
$450.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$688.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$482.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.99
|
| Rate for Payer: Molina Healthcare Passport |
$450.97
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$627.47
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$455.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.67
|
|
|
REMOVAL OF TOE
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28150
|
| Hospital Charge Code |
76102899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL OF TOE
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28150
|
| Hospital Charge Code |
76102899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
REMOVAL OF TOE
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28150
|
| Hospital Charge Code |
76102899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$438.37
|
| Rate for Payer: Ambetter Exchange |
$265.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.02
|
| Rate for Payer: Anthem Medicaid |
$209.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$265.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$318.98
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$483.58
|
| Rate for Payer: Healthspan PPO |
$533.77
|
| Rate for Payer: Humana Medicaid |
$209.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$265.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.06
|
| Rate for Payer: Molina Healthcare Passport |
$209.86
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$345.57
|
| Rate for Payer: UHCCP Medicaid |
$148.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$211.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$265.82
|
|
|
REMOVAL OF TOE LESIONS
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
76100975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.63 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem Medicaid |
$161.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| 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 |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Humana KY Medicaid |
$161.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$163.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.30
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
REMOVAL OF TOE LESIONS
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
76100975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.87 |
| Max. Negotiated Rate |
$514.94 |
| Rate for Payer: Aetna Commercial |
$412.21
|
| Rate for Payer: Ambetter Exchange |
$258.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.87
|
| Rate for Payer: Anthem Medicaid |
$162.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.18
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$464.90
|
| Rate for Payer: Healthspan PPO |
$514.94
|
| Rate for Payer: Humana Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.19
|
| Rate for Payer: Molina Healthcare Passport |
$162.93
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.02
|
| Rate for Payer: UHCCP Medicaid |
$143.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.48
|
|
|
REMOVAL OF TOE LESIONS
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
76100975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.30
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
REMOVAL OF TOE LESIONS(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 28092
|
| Hospital Charge Code |
761P0975
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.87 |
| Max. Negotiated Rate |
$514.94 |
| Rate for Payer: Aetna Commercial |
$412.21
|
| Rate for Payer: Ambetter Exchange |
$258.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.87
|
| Rate for Payer: Anthem Medicaid |
$162.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.18
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$464.90
|
| Rate for Payer: Healthspan PPO |
$514.94
|
| Rate for Payer: Humana Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$166.19
|
| Rate for Payer: Molina Healthcare Passport |
$162.93
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.02
|
| Rate for Payer: UHCCP Medicaid |
$143.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.48
|
|
|
REMOVAL OF TRANS PACEMAKER
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
76101265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.49 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$1,086.94
|
| Rate for Payer: Ambetter Exchange |
$592.51
|
| Rate for Payer: Anthem Medicaid |
$444.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$711.01
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,035.20
|
| Rate for Payer: Healthspan PPO |
$1,068.67
|
| Rate for Payer: Humana Medicaid |
$444.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.38
|
| Rate for Payer: Molina Healthcare Passport |
$444.49
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.26
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.51
|
|
|
REMOVAL OF TRANS PACEMAKER
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
76101265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$1,050.00
|
| 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: Humana Medicare Advantage |
$3,362.64
|
| 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 |
$4,035.17
|
| 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 TRANS PACEMAKER
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
76101265
|
|
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 TRANS PACEMAKER(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 33235
|
| Hospital Charge Code |
761P1265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.49 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$1,086.94
|
| Rate for Payer: Ambetter Exchange |
$592.51
|
| Rate for Payer: Anthem Medicaid |
$444.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$711.01
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,035.20
|
| Rate for Payer: Healthspan PPO |
$1,068.67
|
| Rate for Payer: Humana Medicaid |
$444.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$897.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.38
|
| Rate for Payer: Molina Healthcare Passport |
$444.49
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.26
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.51
|
|
|
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); SINGLE LEAD SYSTEM, ATRIAL OR VENTRICULAR
|
Facility
|
OP
|
$4,707.70
|
|
|
Service Code
|
CPT 33234
|
|
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 TUNNELED CENTRAL VE
|
Facility
|
OP
|
$3,610.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761T1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,241.48 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Aetna Commercial |
$2,779.70
|
| Rate for Payer: Anthem Medicaid |
$1,241.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,815.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$1,805.00
|
| Rate for Payer: Cash Price |
$1,805.00
|
| Rate for Payer: Cigna Commercial |
$2,996.30
|
| Rate for Payer: First Health Commercial |
$3,429.50
|
| Rate for Payer: Humana Commercial |
$3,068.50
|
| Rate for Payer: Humana KY Medicaid |
$1,241.48
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,960.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,266.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,176.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,707.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,140.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.90
|
| Rate for Payer: PHCS Commercial |
$3,465.60
|
| Rate for Payer: United Healthcare All Payer |
$3,176.80
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761P1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$331.49 |
| Rate for Payer: Aetna Commercial |
$312.90
|
| Rate for Payer: Ambetter Exchange |
$177.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.06
|
| Rate for Payer: Anthem Medicaid |
$152.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.01
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: Healthspan PPO |
$331.49
|
| Rate for Payer: Humana Medicaid |
$152.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.75
|
| Rate for Payer: Molina Healthcare Passport |
$152.70
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.76
|
| Rate for Payer: UHCCP Medicaid |
$115.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.51
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,428.90 |
| Max. Negotiated Rate |
$3,988.80 |
| Rate for Payer: Aetna Commercial |
$3,199.35
|
| Rate for Payer: Anthem Medicaid |
$1,428.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,240.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Cash Price |
$2,077.50
|
| Rate for Payer: Cash Price |
$2,077.50
|
| Rate for Payer: Cigna Commercial |
$3,448.65
|
| Rate for Payer: First Health Commercial |
$3,947.25
|
| Rate for Payer: Humana Commercial |
$3,531.75
|
| Rate for Payer: Humana KY Medicaid |
$1,428.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,443.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,407.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,066.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,457.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,656.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,614.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,866.95
|
| Rate for Payer: PHCS Commercial |
$3,988.80
|
| Rate for Payer: United Healthcare All Payer |
$3,656.40
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Professional
|
Both
|
$4,155.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$2,493.00 |
| Rate for Payer: Aetna Commercial |
$312.90
|
| Rate for Payer: Ambetter Exchange |
$177.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$110.06
|
| Rate for Payer: Anthem Medicaid |
$152.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$177.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$177.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$213.01
|
| Rate for Payer: Cash Price |
$2,077.50
|
| Rate for Payer: Cash Price |
$2,077.50
|
| Rate for Payer: Cigna Commercial |
$294.10
|
| Rate for Payer: Healthspan PPO |
$331.49
|
| Rate for Payer: Humana Medicaid |
$152.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$262.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$177.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.75
|
| Rate for Payer: Molina Healthcare Passport |
$152.70
|
| Rate for Payer: Multiplan PHCS |
$2,493.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$230.76
|
| Rate for Payer: UHCCP Medicaid |
$115.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$177.51
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
IP
|
$4,155.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
76101491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,246.50 |
| Max. Negotiated Rate |
$3,988.80 |
| Rate for Payer: Aetna Commercial |
$3,199.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,240.90
|
| Rate for Payer: Cash Price |
$2,077.50
|
| Rate for Payer: Cigna Commercial |
$3,448.65
|
| Rate for Payer: First Health Commercial |
$3,947.25
|
| Rate for Payer: Humana Commercial |
$3,531.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,407.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,066.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,656.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,116.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,614.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,866.95
|
| Rate for Payer: PHCS Commercial |
$3,988.80
|
| Rate for Payer: United Healthcare All Payer |
$3,656.40
|
|
|
REMOVAL OF TUNNELED CENTRAL VE
|
Facility
|
IP
|
$3,610.00
|
|
|
Service Code
|
HCPCS 36590
|
| Hospital Charge Code |
761T1491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,083.00 |
| Max. Negotiated Rate |
$3,465.60 |
| Rate for Payer: Aetna Commercial |
$2,779.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,815.80
|
| Rate for Payer: Cash Price |
$1,805.00
|
| Rate for Payer: Cigna Commercial |
$2,996.30
|
| Rate for Payer: First Health Commercial |
$3,429.50
|
| Rate for Payer: Humana Commercial |
$3,068.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,960.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,176.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,707.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,140.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.90
|
| Rate for Payer: PHCS Commercial |
$3,465.60
|
| Rate for Payer: United Healthcare All Payer |
$3,176.80
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$2,009.49
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,435.35 |
| Max. Negotiated Rate |
$2,009.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,435.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,009.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,937.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,435.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,722.42
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$799.76
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$799.76 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
|
