|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.10 |
| Max. Negotiated Rate |
$1,197.12 |
| Rate for Payer: Aetna Commercial |
$960.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$972.66
|
| Rate for Payer: Cash Price |
$623.50
|
| Rate for Payer: Cigna Commercial |
$1,035.01
|
| Rate for Payer: First Health Commercial |
$1,184.65
|
| Rate for Payer: Humana Commercial |
$1,059.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,022.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$920.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,097.36
|
| Rate for Payer: Ohio Health Group HMO |
$935.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$860.43
|
| Rate for Payer: PHCS Commercial |
$1,197.12
|
| Rate for Payer: United Healthcare All Payer |
$1,097.36
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$1,247.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$748.20 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Ambetter Exchange |
$38.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$35.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.97
|
| Rate for Payer: Cash Price |
$623.50
|
| Rate for Payer: Cash Price |
$623.50
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$35.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.47
|
| Rate for Payer: Molina Healthcare Passport |
$35.75
|
| Rate for Payer: Multiplan PHCS |
$748.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.80
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.31
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,197.12 |
| Rate for Payer: Aetna Commercial |
$960.19
|
| Rate for Payer: Anthem Medicaid |
$428.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$972.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$623.50
|
| Rate for Payer: Cash Price |
$623.50
|
| Rate for Payer: Cigna Commercial |
$1,035.01
|
| Rate for Payer: First Health Commercial |
$1,184.65
|
| Rate for Payer: Humana Commercial |
$1,059.95
|
| Rate for Payer: Humana KY Medicaid |
$428.84
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$433.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,022.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$920.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$437.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,097.36
|
| Rate for Payer: Ohio Health Group HMO |
$935.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$997.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,084.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$860.43
|
| Rate for Payer: PHCS Commercial |
$1,197.12
|
| Rate for Payer: United Healthcare All Payer |
$1,097.36
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
45000299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.60 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.78
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
45000299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.27 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem Medicaid |
$193.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Humana KY Medicaid |
$193.27
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$195.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.78
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Ambetter Exchange |
$38.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$35.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.97
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$35.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.47
|
| Rate for Payer: Molina Healthcare Passport |
$35.75
|
| Rate for Payer: Multiplan PHCS |
$582.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.80
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.31
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.30 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$844.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.99
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
76102383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.93 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem Medicaid |
$333.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Humana KY Medicaid |
$333.93
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$337.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$844.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.99
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
REMOVE FOREIGN BODY FROM EY(P
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761P2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Ambetter Exchange |
$38.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$35.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.97
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cash Price |
$342.50
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$35.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.47
|
| Rate for Payer: Molina Healthcare Passport |
$35.75
|
| Rate for Payer: Multiplan PHCS |
$411.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.80
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.31
|
|
|
REMOVE FOREIGN BODY FROM EY(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761P2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Ambetter Exchange |
$38.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.67
|
| Rate for Payer: Anthem Medicaid |
$35.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.97
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$75.37
|
| Rate for Payer: Healthspan PPO |
$68.47
|
| Rate for Payer: Humana Medicaid |
$35.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.47
|
| Rate for Payer: Molina Healthcare Passport |
$35.75
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.80
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.31
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.27 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem Medicaid |
$193.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Humana KY Medicaid |
$193.27
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$195.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$197.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.78
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.30 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.17 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVE FOREIGN BODY FROM EY(T
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
761T2382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.60 |
| Max. Negotiated Rate |
$539.52 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$438.36
|
| Rate for Payer: Cash Price |
$281.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: First Health Commercial |
$533.90
|
| Rate for Payer: Humana Commercial |
$477.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$460.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$414.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$494.56
|
| Rate for Payer: Ohio Health Group HMO |
$421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.78
|
| Rate for Payer: PHCS Commercial |
$539.52
|
| Rate for Payer: United Healthcare All Payer |
$494.56
|
|
|
REMOVE FOREIGN BODY UPPER ARM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.75 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Anthem Medicaid |
$154.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.00
|
| 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 |
$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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 FOREIGN BODY UPPER ARM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
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 FOREIGN BODY UPPER ARM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
76100514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$322.21 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Ambetter Exchange |
$135.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.68
|
| Rate for Payer: Anthem Medicaid |
$66.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.06
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$322.21
|
| Rate for Payer: Healthspan PPO |
$244.63
|
| Rate for Payer: Humana Medicaid |
$66.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.99
|
| Rate for Payer: Molina Healthcare Passport |
$66.66
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.64
|
| Rate for Payer: UHCCP Medicaid |
$76.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.88
|
|
|
REMOVE FOREIGN BODY UPPER AR(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
761P0514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$322.21 |
| Rate for Payer: Aetna Commercial |
$192.99
|
| Rate for Payer: Ambetter Exchange |
$135.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$72.68
|
| Rate for Payer: Anthem Medicaid |
$66.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$163.06
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$322.21
|
| Rate for Payer: Healthspan PPO |
$244.63
|
| Rate for Payer: Humana Medicaid |
$66.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.99
|
| Rate for Payer: Molina Healthcare Passport |
$66.66
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$176.64
|
| Rate for Payer: UHCCP Medicaid |
$76.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.88
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 28107
|
| Hospital Charge Code |
76100978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVE/GRAFT FOOT LESION
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 28107
|
| Hospital Charge Code |
76100978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
REMOVE/GRAFT FOOT LESION
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28107
|
| Hospital Charge Code |
76100978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.46 |
| Max. Negotiated Rate |
$705.18 |
| Rate for Payer: Aetna Commercial |
$585.85
|
| Rate for Payer: Ambetter Exchange |
$330.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.46
|
| Rate for Payer: Anthem Medicaid |
$293.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.19
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$640.02
|
| Rate for Payer: Healthspan PPO |
$705.18
|
| Rate for Payer: Humana Medicaid |
$293.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$446.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.30
|
| Rate for Payer: Molina Healthcare Passport |
$293.43
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.21
|
| Rate for Payer: UHCCP Medicaid |
$184.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.16
|
|
|
REMOVE/GRAFT FOOT LESION(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28107
|
| Hospital Charge Code |
761P0978
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.46 |
| Max. Negotiated Rate |
$705.18 |
| Rate for Payer: Aetna Commercial |
$585.85
|
| Rate for Payer: Ambetter Exchange |
$330.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.46
|
| Rate for Payer: Anthem Medicaid |
$293.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.19
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$640.02
|
| Rate for Payer: Healthspan PPO |
$705.18
|
| Rate for Payer: Humana Medicaid |
$293.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$446.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$299.30
|
| Rate for Payer: Molina Healthcare Passport |
$293.43
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.21
|
| Rate for Payer: UHCCP Medicaid |
$184.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$296.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.16
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 25126
|
| Hospital Charge Code |
76100588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 25126
|
| Hospital Charge Code |
76100588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| 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 |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25125
|
| Hospital Charge Code |
76100587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
