|
REMOVE DRUG IMPLANT DEVICE(T
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
761T0118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem Medicaid |
$427.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Humana KY Medicaid |
$427.12
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$431.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
REMOVE DRUG IMPLANT DEVICE(T
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 11982
|
| Hospital Charge Code |
761T0118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
REMOVE EAR CANAL LESION(S)
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.76 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
REMOVE EAR CANAL LESION(S)
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
76102407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.32 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$1,217.95
|
| Rate for Payer: Ambetter Exchange |
$825.45
|
| Rate for Payer: Anthem Medicaid |
$461.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$825.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$990.54
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,214.14
|
| Rate for Payer: Healthspan PPO |
$1,080.38
|
| Rate for Payer: Humana Medicaid |
$461.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,106.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$825.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.55
|
| Rate for Payer: Molina Healthcare Passport |
$461.32
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,073.09
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$825.45
|
|
|
REMOVE EAR CANAL LESION(S)(P
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 69140
|
| Hospital Charge Code |
761P2407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.32 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$1,217.95
|
| Rate for Payer: Ambetter Exchange |
$825.45
|
| Rate for Payer: Anthem Medicaid |
$461.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$825.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$990.54
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,214.14
|
| Rate for Payer: Healthspan PPO |
$1,080.38
|
| Rate for Payer: Humana Medicaid |
$461.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,106.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$825.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$825.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.55
|
| Rate for Payer: Molina Healthcare Passport |
$461.32
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,073.09
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$825.45
|
|
|
REMOVE ELBOW LESION
|
Facility
|
OP
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,141.81 |
| Max. Negotiated Rate |
$5,978.88 |
| Rate for Payer: Aetna Commercial |
$4,795.56
|
| Rate for Payer: Anthem Medicaid |
$2,141.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,857.84
|
| 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 |
$3,114.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$5,169.24
|
| Rate for Payer: First Health Commercial |
$5,916.60
|
| Rate for Payer: Humana Commercial |
$5,293.80
|
| Rate for Payer: Humana KY Medicaid |
$2,141.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,163.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,106.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,596.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,184.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,480.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,418.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,297.32
|
| Rate for Payer: PHCS Commercial |
$5,978.88
|
| Rate for Payer: United Healthcare All Payer |
$5,480.64
|
|
|
REMOVE ELBOW LESION
|
Professional
|
Both
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$3,736.80 |
| Rate for Payer: Aetna Commercial |
$756.80
|
| Rate for Payer: Ambetter Exchange |
$511.47
|
| Rate for Payer: Anthem Medicaid |
$371.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.76
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$831.35
|
| Rate for Payer: Healthspan PPO |
$685.50
|
| Rate for Payer: Humana Medicaid |
$371.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.35
|
| Rate for Payer: Molina Healthcare Passport |
$371.91
|
| Rate for Payer: Multiplan PHCS |
$3,736.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.91
|
| Rate for Payer: UHCCP Medicaid |
$2,179.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.47
|
|
|
REMOVE ELBOW LESION
|
Facility
|
IP
|
$6,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
76100509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,868.40 |
| Max. Negotiated Rate |
$5,978.88 |
| Rate for Payer: Aetna Commercial |
$4,795.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,857.84
|
| Rate for Payer: Cash Price |
$3,114.00
|
| Rate for Payer: Cigna Commercial |
$5,169.24
|
| Rate for Payer: First Health Commercial |
$5,916.60
|
| Rate for Payer: Humana Commercial |
$5,293.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,106.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,596.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,868.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,480.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,671.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,418.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,297.32
|
| Rate for Payer: PHCS Commercial |
$5,978.88
|
| Rate for Payer: United Healthcare All Payer |
$5,480.64
|
|
|
REMOVE ELBOW LESION(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761P0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$831.35 |
| Rate for Payer: Aetna Commercial |
$756.80
|
| Rate for Payer: Ambetter Exchange |
$511.47
|
| Rate for Payer: Anthem Medicaid |
$371.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.76
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$831.35
|
| Rate for Payer: Healthspan PPO |
$685.50
|
| Rate for Payer: Humana Medicaid |
$371.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$645.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.35
|
| Rate for Payer: Molina Healthcare Passport |
$371.91
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.91
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.47
|
|
|
REMOVE ELBOW LESION(T
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761T0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,711.93 |
| Max. Negotiated Rate |
$4,778.88 |
| Rate for Payer: Aetna Commercial |
$3,833.06
|
| Rate for Payer: Anthem Medicaid |
$1,711.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,882.84
|
| 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 |
$2,489.00
|
| Rate for Payer: Cash Price |
$2,489.00
|
| Rate for Payer: Cigna Commercial |
$4,131.74
|
| Rate for Payer: First Health Commercial |
$4,729.10
|
| Rate for Payer: Humana Commercial |
$4,231.30
|
| Rate for Payer: Humana KY Medicaid |
$1,711.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,729.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,081.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,746.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,330.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,434.82
|
| Rate for Payer: PHCS Commercial |
$4,778.88
|
| Rate for Payer: United Healthcare All Payer |
$4,380.64
|
|
|
REMOVE ELBOW LESION(T
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
761T0509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,493.40 |
| Max. Negotiated Rate |
$4,778.88 |
| Rate for Payer: Aetna Commercial |
$3,833.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,882.84
|
| Rate for Payer: Cash Price |
$2,489.00
|
| Rate for Payer: Cigna Commercial |
$4,131.74
|
| Rate for Payer: First Health Commercial |
$4,729.10
|
| Rate for Payer: Humana Commercial |
$4,231.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,081.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,493.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,982.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,330.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,434.82
|
| Rate for Payer: PHCS Commercial |
$4,778.88
|
| Rate for Payer: United Healthcare All Payer |
$4,380.64
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.50 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.75
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.08 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Aetna Commercial |
$1,478.50
|
| Rate for Payer: Ambetter Exchange |
$802.70
|
| Rate for Payer: Anthem Medicaid |
$524.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$802.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$802.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$963.24
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,404.18
|
| Rate for Payer: Healthspan PPO |
$1,453.65
|
| Rate for Payer: Humana Medicaid |
$524.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,209.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$802.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$534.56
|
| Rate for Payer: Molina Healthcare Passport |
$524.08
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,043.51
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$802.70
|
|
|
REMOVE ELCTRD TRANSVENOUSLY
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
76101269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,057.49 |
| Max. Negotiated Rate |
$4,707.70 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,362.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| 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 |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Humana Medicare Advantage |
$3,362.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,035.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.75
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
REMOVE ELCTRD TRANSVENOUSLY(P
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33244
|
| Hospital Charge Code |
761P1269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.08 |
| Max. Negotiated Rate |
$1,845.00 |
| Rate for Payer: Aetna Commercial |
$1,478.50
|
| Rate for Payer: Ambetter Exchange |
$802.70
|
| Rate for Payer: Anthem Medicaid |
$524.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$802.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$802.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$963.24
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,404.18
|
| Rate for Payer: Healthspan PPO |
$1,453.65
|
| Rate for Payer: Humana Medicaid |
$524.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,209.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$802.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$802.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$534.56
|
| Rate for Payer: Molina Healthcare Passport |
$524.08
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,043.51
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$802.70
|
|
|
REMOVE ELTRD/THORACOTOMY
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.10
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
REMOVE ELTRD/THORACOTOMY
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,282.01 |
| Rate for Payer: Aetna Commercial |
$2,282.01
|
| Rate for Payer: Ambetter Exchange |
$1,291.13
|
| Rate for Payer: Anthem Medicaid |
$909.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,291.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,291.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,549.36
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,161.15
|
| Rate for Payer: Healthspan PPO |
$2,243.66
|
| Rate for Payer: Humana Medicaid |
$909.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,923.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,291.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$927.55
|
| Rate for Payer: Molina Healthcare Passport |
$909.36
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,678.47
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,291.13
|
|
|
REMOVE ELTRD/THORACOTOMY
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
76101268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.10
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
REMOVE ELTRD/THORACOTOMY(P
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 33243
|
| Hospital Charge Code |
761P1268
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,282.01 |
| Rate for Payer: Aetna Commercial |
$2,282.01
|
| Rate for Payer: Ambetter Exchange |
$1,291.13
|
| Rate for Payer: Anthem Medicaid |
$909.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,291.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,291.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,549.36
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,161.15
|
| Rate for Payer: Healthspan PPO |
$2,243.66
|
| Rate for Payer: Humana Medicaid |
$909.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,923.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,291.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$927.55
|
| Rate for Payer: Molina Healthcare Passport |
$909.36
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,678.47
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,291.13
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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
|
|
|
REMOVE EPIDIDYMIS LESION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
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
|
|
|
REMOVE EPIDIDYMIS LESION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
76102141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.49 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$523.05
|
| Rate for Payer: Ambetter Exchange |
$305.26
|
| Rate for Payer: Anthem Medicaid |
$288.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$305.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$305.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.31
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$466.04
|
| Rate for Payer: Healthspan PPO |
$506.45
|
| Rate for Payer: Humana Medicaid |
$288.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$305.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.26
|
| Rate for Payer: Molina Healthcare Passport |
$288.49
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$396.84
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$305.26
|
|
|
REMOVE EPIDIDYMIS LESION(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 54840
|
| Hospital Charge Code |
761P2141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.49 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$523.05
|
| Rate for Payer: Ambetter Exchange |
$305.26
|
| Rate for Payer: Anthem Medicaid |
$288.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$305.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$305.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.31
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$466.04
|
| Rate for Payer: Healthspan PPO |
$506.45
|
| Rate for Payer: Humana Medicaid |
$288.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$305.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$305.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.26
|
| Rate for Payer: Molina Healthcare Passport |
$288.49
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$396.84
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$291.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$305.26
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.23 |
| Max. Negotiated Rate |
$555.09 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Ambetter Exchange |
$303.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.23
|
| Rate for Payer: Anthem Medicaid |
$177.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.43
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$457.11
|
| Rate for Payer: Healthspan PPO |
$555.09
|
| Rate for Payer: Humana Medicaid |
$177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.09
|
| Rate for Payer: Molina Healthcare Passport |
$177.54
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.80
|
| Rate for Payer: UHCCP Medicaid |
$177.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.69
|
|
