|
REMOVAL TUNNELED CVC(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761P1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.79 |
| Max. Negotiated Rate |
$219.00 |
| 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 |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| 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 |
$219.00
|
| 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(T
|
Facility
|
OP
|
$2,276.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761T1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$2,184.96 |
| Rate for Payer: Aetna Commercial |
$1,752.52
|
| Rate for Payer: Anthem Medicaid |
$782.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,775.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,138.00
|
| Rate for Payer: Cash Price |
$1,138.00
|
| Rate for Payer: Cigna Commercial |
$1,889.08
|
| Rate for Payer: First Health Commercial |
$2,162.20
|
| Rate for Payer: Humana Commercial |
$1,934.60
|
| Rate for Payer: Humana KY Medicaid |
$782.72
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$790.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,866.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,679.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$798.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,002.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,707.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,980.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.44
|
| Rate for Payer: PHCS Commercial |
$2,184.96
|
| Rate for Payer: United Healthcare All Payer |
$2,002.88
|
|
|
REMOVAL TUNNELED CVC(T
|
Facility
|
IP
|
$2,276.00
|
|
|
Service Code
|
HCPCS 36589
|
| Hospital Charge Code |
761T1489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$682.80 |
| Max. Negotiated Rate |
$2,184.96 |
| Rate for Payer: Aetna Commercial |
$1,752.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,775.28
|
| Rate for Payer: Cash Price |
$1,138.00
|
| Rate for Payer: Cigna Commercial |
$1,889.08
|
| Rate for Payer: First Health Commercial |
$2,162.20
|
| Rate for Payer: Humana Commercial |
$1,934.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,866.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,679.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,002.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,707.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,820.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,980.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.44
|
| Rate for Payer: PHCS Commercial |
$2,184.96
|
| Rate for Payer: United Healthcare All Payer |
$2,002.88
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
REMOVAL VAD
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.56 |
| Max. Negotiated Rate |
$6,190.40 |
| Rate for Payer: Aetna Commercial |
$6,190.40
|
| Rate for Payer: Ambetter Exchange |
$1,667.62
|
| Rate for Payer: Anthem Medicaid |
$837.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,667.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,667.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,001.14
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$5,781.70
|
| Rate for Payer: Healthspan PPO |
$6,086.37
|
| Rate for Payer: Humana Medicaid |
$837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,104.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,667.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$854.31
|
| Rate for Payer: Molina Healthcare Passport |
$837.56
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,167.91
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$845.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,667.62
|
|
|
REMOVAL VAD
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL VAD
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
76101331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
REMOVAL VAD(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33980
|
| Hospital Charge Code |
761P1331
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$837.56 |
| Max. Negotiated Rate |
$6,190.40 |
| Rate for Payer: Aetna Commercial |
$6,190.40
|
| Rate for Payer: Ambetter Exchange |
$1,667.62
|
| Rate for Payer: Anthem Medicaid |
$837.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,667.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,667.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,001.14
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$5,781.70
|
| Rate for Payer: Healthspan PPO |
$6,086.37
|
| Rate for Payer: Humana Medicaid |
$837.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,104.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,667.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$854.31
|
| Rate for Payer: Molina Healthcare Passport |
$837.56
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,167.91
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$845.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,667.62
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Professional
|
Both
|
$5,120.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.17 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$510.81
|
| Rate for Payer: Ambetter Exchange |
$318.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$300.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.25
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cigna Commercial |
$726.59
|
| Rate for Payer: Healthspan PPO |
$451.14
|
| Rate for Payer: Humana Medicaid |
$300.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$425.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$306.32
|
| Rate for Payer: Molina Healthcare Passport |
$300.31
|
| Rate for Payer: Multiplan PHCS |
$3,072.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$414.10
|
| Rate for Payer: UHCCP Medicaid |
$180.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$303.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.54
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Facility
|
IP
|
$5,120.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,536.00 |
| Max. Negotiated Rate |
$4,915.20 |
| Rate for Payer: Aetna Commercial |
$3,942.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.60
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cigna Commercial |
$4,249.60
|
| Rate for Payer: First Health Commercial |
$4,864.00
|
| Rate for Payer: Humana Commercial |
$4,352.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,532.80
|
| Rate for Payer: PHCS Commercial |
$4,915.20
|
| Rate for Payer: United Healthcare All Payer |
$4,505.60
|
|
|
REMOVE ABDOMINAL WALL LESION
|
Facility
|
OP
|
$5,120.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,915.20 |
| Rate for Payer: Aetna Commercial |
$3,942.40
|
| Rate for Payer: Anthem Medicaid |
$1,760.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,993.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cigna Commercial |
$4,249.60
|
| Rate for Payer: First Health Commercial |
$4,864.00
|
| Rate for Payer: Humana Commercial |
$4,352.00
|
| Rate for Payer: Humana KY Medicaid |
$1,760.77
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,505.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,532.80
|
| Rate for Payer: PHCS Commercial |
$4,915.20
|
| Rate for Payer: United Healthcare All Payer |
$4,505.60
|
|
|
REMOVE ABDOMINAL WALL LESION(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
761P0429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.17 |
| Max. Negotiated Rate |
$726.59 |
| Rate for Payer: Aetna Commercial |
$510.81
|
| Rate for Payer: Ambetter Exchange |
$318.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$300.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$318.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$318.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$382.25
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$726.59
|
| Rate for Payer: Healthspan PPO |
$451.14
|
| Rate for Payer: Humana Medicaid |
$300.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$425.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$318.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$306.32
|
| Rate for Payer: Molina Healthcare Passport |
$300.31
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$414.10
|
| Rate for Payer: UHCCP Medicaid |
$180.78
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$303.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$318.54
|
|
|
REMOVE ABDOMINAL WALL LESION(T
|
Facility
|
OP
|
$4,320.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
761T0429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,485.65 |
| Max. Negotiated Rate |
$4,147.20 |
| Rate for Payer: Aetna Commercial |
$3,326.40
|
| Rate for Payer: Anthem Medicaid |
$1,485.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,369.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cigna Commercial |
$3,585.60
|
| Rate for Payer: First Health Commercial |
$4,104.00
|
| Rate for Payer: Humana Commercial |
$3,672.00
|
| Rate for Payer: Humana KY Medicaid |
$1,485.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,500.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,515.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,801.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,758.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,980.80
|
| Rate for Payer: PHCS Commercial |
$4,147.20
|
| Rate for Payer: United Healthcare All Payer |
$3,801.60
|
|
|
REMOVE ABDOMINAL WALL LESION(T
|
Facility
|
IP
|
$4,320.00
|
|
|
Service Code
|
HCPCS 22902
|
| Hospital Charge Code |
761T0429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,296.00 |
| Max. Negotiated Rate |
$4,147.20 |
| Rate for Payer: Aetna Commercial |
$3,326.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,369.60
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cigna Commercial |
$3,585.60
|
| Rate for Payer: First Health Commercial |
$4,104.00
|
| Rate for Payer: Humana Commercial |
$3,672.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,801.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,758.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,980.80
|
| Rate for Payer: PHCS Commercial |
$4,147.20
|
| Rate for Payer: United Healthcare All Payer |
$3,801.60
|
|
|
REMOVE ADENOIDS UNDER 12 YRS
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
REMOVE ADENOIDS UNDER 12 YRS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$297.08 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Ambetter Exchange |
$201.59
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.91
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$293.71
|
| Rate for Payer: Healthspan PPO |
$250.53
|
| Rate for Payer: Humana Medicaid |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.84
|
| Rate for Payer: Molina Healthcare Passport |
$147.88
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.07
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.59
|
|
|
REMOVE ADENOIDS UNDER 12 YRS
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
76101710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$373.50
|
| Rate for Payer: First Health Commercial |
$427.50
|
| Rate for Payer: Humana Commercial |
$382.50
|
| Rate for Payer: Humana KY Medicaid |
$154.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.00
|
| Rate for Payer: Ohio Health Group HMO |
$337.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.50
|
| Rate for Payer: PHCS Commercial |
$432.00
|
| Rate for Payer: United Healthcare All Payer |
$396.00
|
|
|
REMOVE ADENOIDS UNDER 12 YRS(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 42830
|
| Hospital Charge Code |
761P1710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$297.08 |
| Rate for Payer: Aetna Commercial |
$297.08
|
| Rate for Payer: Ambetter Exchange |
$201.59
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$241.91
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$293.71
|
| Rate for Payer: Healthspan PPO |
$250.53
|
| Rate for Payer: Humana Medicaid |
$147.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$267.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$150.84
|
| Rate for Payer: Molina Healthcare Passport |
$147.88
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.07
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$149.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.59
|
|
|
REMOVE ANAL FISTULA 2 STAGE
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 46285
|
| Hospital Charge Code |
76102981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.46 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Aetna Commercial |
$534.83
|
| Rate for Payer: Ambetter Exchange |
$402.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.85
|
| Rate for Payer: Anthem Medicaid |
$185.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.76
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$475.32
|
| Rate for Payer: Healthspan PPO |
$548.07
|
| Rate for Payer: Humana Medicaid |
$185.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$498.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.17
|
| Rate for Payer: Molina Healthcare Passport |
$185.46
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.99
|
| Rate for Payer: UHCCP Medicaid |
$228.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.30
|
|
|
REMOVE ANKLE JOINT LINING
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 27626
|
| Hospital Charge Code |
76102747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.75 |
| Max. Negotiated Rate |
$1,051.09 |
| Rate for Payer: Aetna Commercial |
$953.43
|
| Rate for Payer: Ambetter Exchange |
$582.98
|
| Rate for Payer: Anthem Medicaid |
$570.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$582.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$582.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$699.58
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$1,051.09
|
| Rate for Payer: Healthspan PPO |
$863.61
|
| Rate for Payer: Humana Medicaid |
$570.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$783.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$582.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.21
|
| Rate for Payer: Molina Healthcare Passport |
$570.79
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$757.87
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$582.98
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
REMOVE BLADDER STONE
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$1,193.83 |
| Rate for Payer: Aetna Commercial |
$581.58
|
| Rate for Payer: Ambetter Exchange |
$325.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$377.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.58
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$519.96
|
| Rate for Payer: Healthspan PPO |
$1,193.83
|
| Rate for Payer: Humana Medicaid |
$377.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$325.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.10
|
| Rate for Payer: Molina Healthcare Passport |
$377.55
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$423.12
|
| Rate for Payer: UHCCP Medicaid |
$182.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.48
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
76102099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REMOVE BLADDER STONE
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 52318
|
| Hospital Charge Code |
76102099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REMOVE BLADDER STONE
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 52317
|
| Hospital Charge Code |
76102098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| 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 |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
