|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
REMOVAL OF URETHRA LESION
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$974.19 |
| Rate for Payer: Aetna Commercial |
$974.19
|
| Rate for Payer: Ambetter Exchange |
$577.86
|
| Rate for Payer: Anthem Medicaid |
$497.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$577.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$577.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$693.43
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$873.76
|
| Rate for Payer: Healthspan PPO |
$778.96
|
| Rate for Payer: Humana Medicaid |
$497.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$828.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$577.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$507.10
|
| Rate for Payer: Molina Healthcare Passport |
$497.16
|
| Rate for Payer: Multiplan PHCS |
$892.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$751.22
|
| Rate for Payer: UHCCP Medicaid |
$520.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$502.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$577.86
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.72 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$1,145.76
|
| Rate for Payer: Anthem Medicaid |
$511.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,235.04
|
| Rate for Payer: First Health Commercial |
$1,413.60
|
| Rate for Payer: Humana Commercial |
$1,264.80
|
| Rate for Payer: Humana KY Medicaid |
$511.72
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$516.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$521.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.72
|
| Rate for Payer: PHCS Commercial |
$1,428.48
|
| Rate for Payer: United Healthcare All Payer |
$1,309.44
|
|
|
REMOVAL OF URETHRA LESION
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
HCPCS 53230
|
| Hospital Charge Code |
76102927
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.40 |
| Max. Negotiated Rate |
$1,428.48 |
| Rate for Payer: Aetna Commercial |
$1,145.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.64
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cigna Commercial |
$1,235.04
|
| Rate for Payer: First Health Commercial |
$1,413.60
|
| Rate for Payer: Humana Commercial |
$1,264.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.72
|
| Rate for Payer: PHCS Commercial |
$1,428.48
|
| Rate for Payer: United Healthcare All Payer |
$1,309.44
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
|
Facility
|
OP
|
$2,950.29
|
|
|
Service Code
|
CPT 67005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,107.35 |
| Max. Negotiated Rate |
$2,950.29 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,107.35
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,950.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,844.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,107.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.82
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| 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 |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.28 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$755.55
|
| Rate for Payer: Ambetter Exchange |
$511.78
|
| Rate for Payer: Anthem Medicaid |
$358.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$614.14
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$833.51
|
| Rate for Payer: Healthspan PPO |
$684.37
|
| Rate for Payer: Humana Medicaid |
$358.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.45
|
| Rate for Payer: Molina Healthcare Passport |
$358.28
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.31
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.78
|
|
|
REMOVAL OF WRIST PROSTHESIS
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
76100596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVAL OF WRIST PROSTHESIS(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 25250
|
| Hospital Charge Code |
761P0596
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.28 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$755.55
|
| Rate for Payer: Ambetter Exchange |
$511.78
|
| Rate for Payer: Anthem Medicaid |
$358.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$614.14
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$833.51
|
| Rate for Payer: Healthspan PPO |
$684.37
|
| Rate for Payer: Humana Medicaid |
$358.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$365.45
|
| Rate for Payer: Molina Healthcare Passport |
$358.28
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.31
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.78
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761T2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$121.92 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761P2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Ambetter Exchange |
$31.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$35.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$95.87
|
| Rate for Payer: Healthspan PPO |
$80.05
|
| Rate for Payer: Humana Medicaid |
$35.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.33
|
| Rate for Payer: Molina Healthcare Passport |
$35.62
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.95
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.50
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
761T2631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$343.55 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Anthem Medicaid |
$43.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: First Health Commercial |
$120.65
|
| Rate for Payer: Humana Commercial |
$107.95
|
| Rate for Payer: Humana KY Medicaid |
$43.68
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$44.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.76
|
| Rate for Payer: Ohio Health Group HMO |
$95.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$87.63
|
| Rate for Payer: PHCS Commercial |
$121.92
|
| Rate for Payer: United Healthcare All Payer |
$111.76
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$343.55 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$98.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$245.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$343.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.28
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$98.70
|
| Rate for Payer: Humana Medicare Advantage |
$245.39
|
| Rate for Payer: Kentucky WC Medicaid |
$99.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.03
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 29700
|
| Hospital Charge Code |
76102631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$172.20 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Ambetter Exchange |
$31.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.79
|
| Rate for Payer: Anthem Medicaid |
$35.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.80
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$95.87
|
| Rate for Payer: Healthspan PPO |
$80.05
|
| Rate for Payer: Humana Medicaid |
$35.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.33
|
| Rate for Payer: Molina Healthcare Passport |
$35.62
|
| Rate for Payer: Multiplan PHCS |
$172.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$40.95
|
| Rate for Payer: UHCCP Medicaid |
$17.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.50
|
|
|
REMOVAL, SUBCUTANEOUS CARDIAC RHYTHM MONITOR
|
Facility
|
OP
|
$910.14
|
|
|
Service Code
|
CPT 33286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$650.10 |
| Max. Negotiated Rate |
$910.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$26.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$26.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.13
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Ambetter Exchange |
$12.71
|
| Rate for Payer: Anthem Medicaid |
$12.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.25
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Humana Medicaid |
$12.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.68
|
| Rate for Payer: Molina Healthcare Passport |
$12.43
|
| Rate for Payer: Multiplan PHCS |
$46.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$16.52
|
| Rate for Payer: UHCCP Medicaid |
$26.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.71
|
|
|
REMOVAL SUTR&STAPL XREQ ANES
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 15854
|
| Hospital Charge Code |
76102869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.13
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Ambetter Exchange |
$10.06
|
| Rate for Payer: Anthem Medicaid |
$8.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Humana Medicaid |
$8.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$10.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.99
|
| Rate for Payer: Molina Healthcare Passport |
$8.81
|
| Rate for Payer: Multiplan PHCS |
$21.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.08
|
| Rate for Payer: UHCCP Medicaid |
$12.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.06
|
|
|
REMOVAL SUTR/STAPL XREQ ANES
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS 15853
|
| Hospital Charge Code |
76102868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.08
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$29.88
|
| Rate for Payer: First Health Commercial |
$34.20
|
| Rate for Payer: Humana Commercial |
$30.60
|
| Rate for Payer: Humana KY Medicaid |
$12.38
|
| Rate for Payer: Kentucky WC Medicaid |
$12.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$31.68
|
| Rate for Payer: Ohio Health Group HMO |
$27.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.84
|
| Rate for Payer: PHCS Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Payer |
$31.68
|
|
|
REMOVAL TUNNELED CVC
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$2,535.36 |
| Rate for Payer: Aetna Commercial |
$2,033.57
|
| Rate for Payer: Anthem Medicaid |
$908.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,320.50
|
| Rate for Payer: Cash Price |
$1,320.50
|
| Rate for Payer: Cigna Commercial |
$2,192.03
|
| Rate for Payer: First Health Commercial |
$2,508.95
|
| Rate for Payer: Humana Commercial |
$2,244.85
|
| Rate for Payer: Humana KY Medicaid |
$908.24
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$917.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,165.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,949.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$926.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,324.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,297.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,822.29
|
| Rate for Payer: PHCS Commercial |
$2,535.36
|
| Rate for Payer: United Healthcare All Payer |
$2,324.08
|
|
|
REMOVAL TUNNELED CVC
|
Professional
|
Both
|
$2,641.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$1,584.60 |
| Rate for Payer: Aetna Commercial |
$218.24
|
| Rate for Payer: Ambetter Exchange |
$127.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.79
|
| Rate for Payer: Anthem Medicaid |
$126.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$127.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$127.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$153.05
|
| Rate for Payer: Cash Price |
$1,320.50
|
| Rate for Payer: Cash Price |
$1,320.50
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Healthspan PPO |
$203.61
|
| Rate for Payer: Humana Medicaid |
$126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$179.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$127.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.79
|
| Rate for Payer: Molina Healthcare Passport |
$126.26
|
| Rate for Payer: Multiplan PHCS |
$1,584.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.80
|
| Rate for Payer: UHCCP Medicaid |
$95.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$127.54
|
|
|
REMOVAL TUNNELED CVC
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
76101489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$792.30 |
| Max. Negotiated Rate |
$2,535.36 |
| Rate for Payer: Aetna Commercial |
$2,033.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.98
|
| Rate for Payer: Cash Price |
$1,320.50
|
| Rate for Payer: Cigna Commercial |
$2,192.03
|
| Rate for Payer: First Health Commercial |
$2,508.95
|
| Rate for Payer: Humana Commercial |
$2,244.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,165.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,949.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$792.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,324.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,297.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,822.29
|
| Rate for Payer: PHCS Commercial |
$2,535.36
|
| Rate for Payer: United Healthcare All Payer |
$2,324.08
|
|
